Get and Keep Medicaid and Other Health Coverage
The coverage system is an obstacle course of forms, deadlines, and verifications, and a single missed step can cost you coverage even when you clearly qualify. This is your guide through all of it: figure out what you qualify for, apply, keep it, and appeal if you are denied or dropped.
Where are you in the process?
Pick one and we will point you to the right step. Nothing is saved.
The four stages, and where to get help with each
1. Screen
Find out what you may qualify for (Medicaid, CHIP, subsidies, Medicare Savings, charity care).
Do I qualify?2. Apply
Get approved without tripping a technicality. The state must decide within 45 days (90 if disability-based).
Start your application3. Maintain
Keep it at renewal, and handle the new work requirements. Most people who lose Medicaid still qualified.
Keep your coverage4. Appeal
Denied or dropped? You have the right to a fair hearing, and appealing on time can keep coverage running.
Appeal a decisionWhat to gather so you don't get denied on a technicality
The most common avoidable denials come from missing documents or a verification the state requested and never got back. Have these ready before you apply or renew:
- Photo ID for each applicant (driver license, state ID, or other identity proof).
- Social Security numbers (or proof of application) for those applying.
- Proof of income: recent pay stubs, a benefits letter, or a tax return.
- Proof of where you live (a lease, utility bill, or official mail).
- Immigration or citizenship documents, if applicable.
- For a child or pregnancy application: birth certificates or proof of pregnancy.
Your state will tell you exactly what it needs; requirements vary. If the state asks for more information, respond by the date on the notice, that request is a leading cause of otherwise-avoidable denials.
If you don't qualify
In states that did not expand Medicaid (like Texas), many adults fall into a coverage gap and will not qualify for regular Medicaid. We will not pretend otherwise. If that is you, your real backstops are hospital charity care, county and hospital-district programs, and Emergency Medicaid for emergencies.
Already have a medical bill?
Applying, renewing, and appealing are free, use a navigator or legal aid if you want help (LocalHelp.HealthCare.gov or 2-1-1). Where CareRoute helps is the bill: if you already have a medical bill, including one from a gap in coverage, send it to us and we will review and negotiate it. Free to submit, you only pay if we save you money.
Send us the billFree to submit. You only pay if we save you money.
Frequently asked questions
What is this?
A plain-language guide to getting and keeping government health coverage, mostly Medicaid, plus CHIP, Marketplace subsidies, Medicare Savings Programs, and hospital charity care. It walks you through the whole process: figuring out what you qualify for, applying, keeping it at renewal, handling the new work requirements, and appealing if you are denied or dropped.
Why is getting and keeping coverage so hard?
Because the process is full of forms, deadlines, and verifications, and a single missed step can cost you coverage even when you clearly qualify. In the recent nationwide Medicaid renewals, about 69% of people who lost coverage lost it for paperwork reasons, not because they were found ineligible. Knowing the deadlines and the traps is most of the battle.
Is there free help?
Yes. Trained navigators and assisters help you apply and renew at no cost, find one at LocalHelp.HealthCare.gov or call 2-1-1. Legal-aid offices can help you appeal a denial or termination for free. Use them, funding for this help has been cut recently, but it is still worth reaching for.
What if I do not qualify for any of it?
In states that did not expand Medicaid (like Texas), many adults fall into a coverage gap and will not qualify for regular Medicaid. If that is you, your backstops are hospital charity care, county and hospital-district programs, and Emergency Medicaid. Our charity-care finder points you to the ones near you.
How does CareRoute make money if the help is free?
The guides and tools here are free, and we point you to free help to apply and appeal. CareRoute is paid through Bill Defense: if you already have a medical bill (including one from a coverage gap), we review and negotiate it, and you only pay if we save you money. We do not charge you to get or keep coverage.
Related
Sources & references
This is general information, not legal or benefits advice, and does not create a client relationship. Eligibility rules, deadlines, and program details vary by state and change over time, always confirm with your state Medicaid agency or the Marketplace, and follow the dates on any notice you receive. Last updated: August 2026.