Most Medicaid applications take up to 45 days to decide; cases needing a disability decision can take up to 90 days.
When you apply for Medicaid, the agency has a set window to make a decision. For most adults and families, the target is within 45 days from the date the agency gets a complete submission. If the decision hinges on a disability finding, the window extends to 90 days. The sections below map out what triggers those clocks, how the steps unfold, what can slow a decision, and how to nudge a stalled file forward without guesswork.
Medicaid Application Review Timeline — What To Expect
Two federal timing standards guide every state. One applies to income-based files; the other covers cases that need a disability ruling. States must work cases “promptly and without undue delay,” but they still need verifications from you and from third parties. That’s where time can stretch. Use this section to see where your file fits and how to keep it moving.
Timing Standards In Plain Terms
The agency counts calendar days, not business days. The clock starts when the office or online portal receives your application, even if a worker opens it later. If your packet is missing proof, the agency pauses its work and sends a request. Once you respond, work resumes. If disability evidence is required, the decision timeframe is longer because medical records and a disability determination must land before eligibility is set.
| Situation | Target Decision Time | What Starts The Clock |
|---|---|---|
| Income-based application (MAGI) | Up to 45 calendar days | Agency receives your submission |
| Case needing a disability decision | Up to 90 calendar days | Agency receives your submission |
| Switched from Marketplace to Medicaid | Same 45/90-day standards | Date the account transfers in |
Step-By-Step: What Happens After You Apply
- Receipt & File Setup: Your application enters the state system. You’ll usually get a confirmation number or notice.
- Screening For Program Fit: A worker or rules engine checks your household size, income, age, disability path, and citizenship/immigration status.
- Requests For Proof: If the system can’t verify income, identity, or residency through data matches, the office asks you for documents. A request sets a clear due date. Missed due dates can stall or close the file.
- Disability Track (If Needed): Files that hinge on disability route to the state’s disability unit or to a partner agency for a determination. Medical records and provider statements are gathered.
- Decision Notice: You receive a written notice that approves, pends, or denies. It explains what coverage you get and when it starts, or what’s missing and how to appeal.
What Influences How Long A Medicaid Decision Takes
The 45- and 90-day clocks apply across states, but real-world speed varies. The biggest swings come from document gaps, identity mismatches, and disability evidence. System backlogs and mailed paperwork can add days. The tips below keep the process tight.
Factors That Slow Decisions
- Missing Proof: No pay stubs or self-employment logs, or a mismatch between what you reported and what a data source shows.
- Identity Or Citizenship Flags: Name changes, hyphenated surnames, or records that don’t match across agencies.
- Medical Record Delays: For disability paths, clinics can take weeks to send records without a signed release and precise dates of service.
- Returned Mail: Notices sent to an old address lead to missed deadlines and closures.
- Portal Upload Errors: Photos that are unreadable or sideways, or PDFs without page numbers.
Proof Checklist To Keep Your File On Track
- Identity: State ID or driver’s license, or another approved photo ID.
- Residency: Lease, utility bill, or a dated letter from a shelter or host.
- Income: Last 30 days of pay stubs; for gig work, a ledger with dates and amounts. Add a short statement if income fluctuates.
- Citizenship/Immigration: Birth certificate, passport, or eligible status document.
- Medical Releases (Disability Files): Signed forms naming each provider, covering at least 12 months of records tied to the claim.
When The Clock Resets Or Pauses
Timing questions pop up when a case moves from one basis to another, or when the office is waiting on you. If you are found ineligible on a MAGI path and the agency checks disability next, a fresh 90-day limit applies to that new basis. When the office requests proof and sets a due date, the time they spend waiting for your response doesn’t count against their internal workflow targets. The fastest route is to send clean, legible files in a single upload with clear labels.
How To Label Documents For Speed
- Use file names like 2025-09-stubs-Jane-Doe.pdf or Lease-Unit12-Aug2025.jpg.
- Combine multi-page scans into one PDF and number the pages.
- Circle pay dates or write them in the margin before scanning.
Where To Check Status And Get Help
Every state runs a portal and hotline for status checks. If your letter has a case number, you can usually look up the file online. The national site points you to the right office. You can also reach out to a local navigator, legal services office, or a hospital financial counselor if you hit a snag.
Use Medicaid’s help page to find your state’s portal and contact lines. Many states also show processing dashboards and publish the share of files finished within one week, one month, and so on. Those snapshots give you a sense of pace during busy seasons.
What A Typical Status Page Shows
- Whether your file is pending, approved, or denied.
- Which verifications are still needed and the exact due date.
- Any scheduled interview or a note that an interview isn’t needed.
- The mail date for your decision notice or ID card, once approved.
Your Rights If A Decision Takes Too Long
If your file sits past the standard window and you sent everything the office asked for, you can request a fair hearing. A hearing is a formal way to ask the agency to decide the case promptly. You can also ask for an informal review, but a hearing request protects your place and sets a firm timeline for action. The hearing notice explains how to file and where to send the form. Free legal help may be available in your area.
When To Seek A Hearing
- You applied on an income path and 45 days have passed without a decision.
- You applied on a disability path and 90 days have passed without a decision.
- You received a denial that cites missing proof you already sent.
States must rule on hearing requests and carry out decisions on a schedule. If you win, the agency adjusts the start date of coverage to match the rules in your state, often back to the date of application or the first of the month after you applied.
Documented Rules You Can Cite
Federal law sets the 45- and 90-day standards. You can read the exact language in 42 C.F.R. § 435.912. CMS also reminded states of these timelines in a 2024 bulletin that covers both Medicaid and CHIP. If you need a ready reference to share with a caseworker or advocate, see the May 9, 2024 CMCS informational bulletin that restates the same 45-day and 90-day limits.
How Long Files Take In Practice
Plenty of cases clear far faster than the outer limits. Many states process a large share of income-based files within a week when the system can verify income and identity through data matches. During renewal waves or staffing shortages, more files push toward the outer edge of the window. States publish scorecards that show how often files close within one day, one week, or a month. Those metrics give a realistic sense of pace where you live.
What The Numbers Say Right Now
National snapshots show that a big portion of income-based applications close within seven days, while tougher proofs stretch longer. States also track what share goes past 45 days so they can spot pinch points. Check your state’s dashboard or public reports if speed is a concern where you live.
How To Speed Up A Pending File
You can’t control staffing or mail slowdowns, but you can keep your part clean and complete. The checklist below targets the most common stalls and the fastest fixes.
| Issue | Impact On Timing | What To Do |
|---|---|---|
| Missing pay proof | Stops work until received | Upload last 30 days of stubs; add dated self-employment log if needed |
| Name mismatch | Triggers identity review | Upload photo ID and a document with current name; add brief note |
| Citizenship check | Waits for primary evidence | Send birth certificate or passport; if not available, send secondary proof |
| Medical records lag | Slows disability ruling | Sign releases for each clinic; list dates of service; call clinics to confirm fax |
| Unreadable uploads | Worker can’t verify data | Rescan as PDF, upright, 300 dpi; add page numbers |
| Address changed | Missed notices | Update the portal and call the hotline the same day |
What Approval Timing Means For Coverage Start Dates
Medicaid coverage can reach back to bills from the three months before you applied if you were eligible during those months and your state allows retroactive coverage under its plan. That safety net is separate from processing time. If you need to start care now, ask providers about coverage screening and hospital presumptive eligibility options in your state. Some clinics can enroll eligible patients on the spot for short-term coverage while the full file is pending.
If You’re Switching From Marketplace To Medicaid
When income drops mid-year, the Marketplace sends your account to the state. The same 45- and 90-day standards apply after the transfer. Keep your Marketplace plan active until the Medicaid approval lands, so you avoid a gap. Once Medicaid starts, the Marketplace plan can end prospectively or retroactively based on coordination rules.
How To Set Yourself Up For A Smooth Decision
- Apply Online If Possible: Uploads arrive instantly and you get a receipt.
- Answer Every Field: Blank fields trigger proof requests. If something doesn’t apply, write “N/A.”
- Link Every Household Member: List everyone who files taxes together and anyone claimed as a dependent.
- Pick A Contact Method You Check Daily: Many states send portal messages that mirror mail notices.
- Keep Copies: Save a PDF of your application and every upload so you can resend quickly if asked.
When You Need Care Before A Decision
If you have urgent care needs, tell the office in writing and through the portal. Hospitals and some clinics can screen for short-term coverage paths while your file is pending. If you were eligible before you applied, ask providers to hold bills until the decision lands. Once approved, call the plan or the state to link your member ID to recent claims so payment can process.
Proof That Backs These Timeframes
Two sources set and affirm the timelines used in this guide. The regulation at 42 C.F.R. § 435.912 sets the 45- and 90-day limits. CMS reiterated the same limits in a 2024 bulletin to states: see the CMCS informational bulletin for line-by-line language that caseworkers follow.
Bottom-Line Takeaway
Expect a decision within 45 days for income-based files and within 90 days when a disability ruling is part of the review. You can keep things moving by sending clean proof early, checking the portal weekly, and asking for a hearing if a complete file stalls past the window. If you need care now, ask about short-term coverage while the office finishes your case.