Medicaid and the Children’s Health Insurance Program (CHIP) remain the most reliable way for low‑income adults, kids, pregnant people, seniors, and people with disabilities to get free or very low‑cost health coverage. If your household is struggling to afford premiums, copays, or prescriptions—or you recently lost coverage during renewals—there are concrete steps you can take today to enroll and keep your care uninterrupted.
This guide pulls together the most current federal guidance and practical enrollment tips so you can act with confidence. It focuses on the nuts and bolts: eligibility, how to apply, how to protect your coverage during renewals, and what to do if your situation changes.
Who Medicaid and CHIP cover, in plain terms
- Medicaid basics: In every state, Medicaid provides free or low‑cost coverage for low‑income individuals and families, including children, pregnant people, older adults, and people with disabilities. Some states also cover other low‑income adults depending on state rules. See the overview at HealthCare.gov.
- CHIP basics: CHIP covers children (and sometimes pregnant people) in families that earn too much for Medicaid but still can’t afford private insurance. Learn more via HealthCare.gov’s Medicaid & CHIP page.
- Costs: Coverage is typically free or very low cost. Programs must follow federal rules, but income thresholds, covered services, and cost‑sharing vary by state, as noted by HealthCare.gov.
Key eligibility points you can check today
According to USAGov’s Medicaid & CHIP guidance, states decide the exact criteria, but these factors commonly determine eligibility:
- Household income and family size
- Age (children and people 65+ often qualify under specific categories)
- Pregnancy status
- Disability status
- State residency (you must apply in the state where you live)
Important: You can apply for Medicaid and CHIP any time of year—there’s no limited open enrollment period for these programs (USAGov).
How to apply (and the fastest way to a decision)
You have two reliable application pathways:
- Apply through your state Medicaid agency. USAGov directs you to your state Medicaid office to start an application and check eligibility rules: How to apply for Medicaid and CHIP.
- Apply through the Health Insurance Marketplace. Create an account and complete an application at HealthCare.gov. If your household appears eligible for Medicaid/CHIP, the Marketplace electronically sends your information to your state agency, which will contact you about next steps (USAGov).
Tip: Use whichever route you can complete right now. The Marketplace path is especially helpful if you’re unsure whether your income qualifies for Medicaid or for Marketplace financial assistance—your application will be triaged to the right program.
What to expect after you enroll
- Some states deliver Medicaid directly; others use private insurance companies (managed care plans) to provide your benefits, as explained by HealthCare.gov.
- If you’re asked to choose a health plan and primary care provider, look for a plan with your current doctors and nearby hospitals in‑network. States and plan administrators often provide comparison tools and quality information—examples include California’s plan materials and quality pages via its Health Care Options portal (DHCS Health Care Options) and North Carolina’s enrollment broker tools (NC Medicaid Enrollment Broker). While your state’s website will differ, expect similar tools and support.
- Many Medicaid managed care programs include support services such as care coordination and, in some states, help scheduling rides to medical appointments. For instance, NC Medicaid offers a “Schedule a ride” feature through its plan support site (NC Medicaid Enrollment Broker). Check your plan’s member materials for the exact benefits available where you live.
How renewals work (and why responding quickly matters in 2025)
States resumed regular Medicaid and CHIP renewals after the pandemic pause. During this “unwinding,” many families—especially kids—lost coverage due to paperwork and missed deadlines even when still eligible. Federal officials published strategies to help states keep eligible children covered and extended certain flexibilities through the end of 2024 (CMS newsroom release). CMS also highlighted that nine states—including Florida—had the highest child disenrollment rates by number and percentage, urging those states to adopt more “keep kids covered” strategies to reduce losses due to red tape (CMS).
What this means for you in 2025:
- Watch your mail, texts, and email for renewal notices from your state or your Medicaid plan. Complete all requested forms by the deadline listed.
- Update your address, phone, and email with your state Medicaid agency now so you receive notices on time. Many state sites prominently offer “find your local office” and “update your info” tools; for example, California’s Health Care Options portal directs members to update contact details and explains yearly renewals (DHCS Health Care Options). Your state’s Medicaid website will have similar functions.
- If your child loses coverage, act quickly. CMS guidance specifically targets preventing unnecessary child disenrollments; if your child is still eligible, you can appeal or reapply to restore coverage (CMS).
If you’re denied or lose Medicaid: your best next options
- Marketplace coverage with financial help: If you are denied Medicaid or you lose it after a renewal, you can typically enroll in a HealthCare.gov plan with subsidies through a Special Enrollment Period (SEP). See the sections “Changing from Marketplace to Medicaid or CHIP” and “Get Marketplace coverage if you lose or are denied Medicaid or CHIP coverage” on HealthCare.gov’s Medicaid & CHIP page.
- CHIP for kids: If family income is too high for Medicaid but still modest, your children may qualify for CHIP. Apply the same way—through your state or the Marketplace—and your application will be routed appropriately (HealthCare.gov).
Avoid gaps and duplicate coverage during transitions
Coverage transitions can be confusing. CMS recently underscored integrity risks during program shifts, noting in July 2025 that millions of people were potentially enrolled in more than one Medicaid or ACA Marketplace plan at the same time. According to the CMS newsroom index of related releases, one July 17, 2025 update found 2.8 million Americans potentially affected.
Practical steps to stay protected:
- If you gain Medicaid, promptly end your Marketplace plan for the day before your Medicaid coverage starts to avoid paying unnecessary premiums.
- If you lose Medicaid, start a Marketplace application immediately to activate your Special Enrollment Period and keep continuous coverage.
- Keep copies of notices and screenshots of application submissions, and write down dates and confirmation numbers.
Retroactive coverage can reduce medical debt
Medicaid may pay for certain medical care from the last three months before you applied (if you were eligible during those months), depending on your state. This “retroactive coverage” can be a lifeline if you had recent hospital or pharmacy bills. HealthCare.gov notes that payment depends on your state’s rules, so ask your state Medicaid office about retroactive eligibility when you apply (HealthCare.gov).
Step‑by‑step: How to get covered now
1) Gather the basics
- Names, dates of birth, and Social Security numbers (if available) for household members
- Proof of state residency and current contact information
- Recent income information (pay stubs or other income documentation)
2) Apply today
- Online at HealthCare.gov, which will route your case to Medicaid/CHIP or Marketplace financial help, or
- Through your state Medicaid agency as directed by USAGov.
3) Respond to any requests
- Watch for texts, emails, mail, or portal messages from your state or plan. Upload or mail documents by the listed deadline.
4) Choose a plan (if prompted)
- If your state uses managed care, you may need to pick a health plan and primary care provider. Look up provider networks and compare plan features using your state’s plan comparison tools (examples: NC Medicaid Enrollment Broker; California Health Care Options).
5) Use your benefits
- Once approved, schedule a primary care visit to establish care. Check your plan materials for covered services, pharmacy rules, and any transportation support noted in member resources (as states like North Carolina highlight through their plan support sites: NC Medicaid Enrollment Broker).
6) Keep your coverage active
- Report address or income changes promptly to your state Medicaid agency.
- Complete annual renewals on time. CMS emphasized that many children lost coverage due to administrative hurdles; act quickly on any renewal notices to avoid a lapse (CMS).
Special notes for Florida parents, seniors, and caregivers
- Children’s coverage continuity is a priority. CMS called out states with high child disenrollment—Florida among them—and urged adoption of strategies to keep eligible kids covered during renewals (CMS). If your child was cut off due to missing paperwork or processing issues, reapply or request a fair hearing promptly.
- Transitions between Medicaid, CHIP, and Marketplace plans are common. The federal Marketplace has dedicated information on moving between programs and enrolling in a Marketplace plan if you lose Medicaid (HealthCare.gov). Use these pathways to keep seeing your doctors and refilling prescriptions without interruption.
When to seek in‑person or phone help
- If your case is complex (disability, fluctuating income, caring for a child or elder with special health needs), ask your state Medicaid office for help via USAGov’s “How to apply” page.
- If you need plan selection help, look for your state’s managed care enrollment broker. While the Florida links are not included here, states typically provide tools similar to NC’s plan chooser or California’s plan materials and quality reports.
Why this matters in 2025
The policy environment continues to evolve. CMS extended key flexibilities to help states keep kids covered through the end of 2024 and is now emphasizing program integrity and smoother transitions across coverage types. The agency also published renewal data and guidance to minimize unnecessary losses and improve handoffs between Medicaid, CHIP, and Marketplace plans (CMS newsroom release and related guidance).
Bottom line: if you need free or low‑cost coverage, apply now—don’t wait for open enrollment. If you’re already enrolled, open every notice, respond by the deadline, and keep your contact information up to date. And if your situation changes, use the