If you choose to use the online application you may submit your application using an electronic signature by clicking the "SIGN NOW" button at the end of the application. Clicking on the "SIGN NOW" button means that you accept responsibility for the correctness of all the information given on this application. Clicking on the "SIGN NOW" button allows Healthy Kids and KidCare to accept and finish working on your online application. If you have any questions about the online application or choose not to submit your application electronically, you may call toll-free 1-888-540-5437 for additional information or to request a paper application. If you are hearing impaired and need assistance please call our toll-free TTY number 1-877-427-9825.

Please review all your information before continuing from step to step.

Continue an application

Confirmation Number:
Last Name:

As entered on your application
(case sensitive)

Use this application to see what coverage choices you qualify for:

  • Free or low-cost insurance from Medicaid or the Children’s Health Insurance Program (CHIP)
  • Affordable private health insurance plans that offer comprehensive coverage to help you stay well
  • A new tax credit that can immediately help pay your premiums for health coverage

Who can use this application?

  • Use this application to apply for anyone in your family.
  • Apply even if you or your child already has health coverage. You could be eligible for lower-cost or free coverage.
  • If you’re single, you may be able to use a short form. Visit HealthCare.gov.
  • Families that include immigrants can apply. You can apply for your child even if you aren’t eligible for coverage. Applying won’t affect your immigration status or chances of becoming a permanent resident or citizen.
  • If someone is helping you fill out this application, you may need to complete Appendix C.

Why do we ask for this information?

We ask about income and other information to let you know what coverage you qualify for and if you can get any help paying for it. We’ll keep all the information you provide private and secure, as required by law.

What you may need to apply

  • Social Security Numbers (or document numbers for any legal immigrants who need insurance)
  • Employer and income information for everyone in your family (for example, from paystubs, W-2 forms, or wage and tax statements)
  • Policy numbers for any current health insurance
  • Information about any job-related health insurance available to your family
  • If more documents are needed, please send copies. Do not send originals.