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How to Apply

There are multiple ways you can apply for Mississippi Medicaid health benefits.

How to Apply for Mississippi Medicaid Health Benefits


Mississippi’s Common Web Portal at is a convenient way  to apply for children, pregnant women, low-income parents of children under age 18 and anyone else who needs to apply. Documents can be uploaded and sent electronically with your application to the Medicaid Regional Office serving your county of residence. Medicaid Specialists in the Regional Office check available electronic sources to verify as much information as possible and then follow-up if additional information is needed. NOTE: If you want to apply for Medicaid due to age, blindness or disability on, be sure to check YES to a limiting or disabling condition when those questions appear in the application flow. This lets us know you are asking for a Medicaid decision that considers age, blindness or disability as a condition of your eligibility.

The Mississippi Division of Medicaid and the federally facilitated marketplace (FFM) has one single application for all insurance affordability programs. Application for any of the insurance affordability programs may be filed online through or the FFM at If you apply through, the FFM will assess  your potential eligibility for Medicaid or CHIP and then return your application to the Division of Medicaid for the final eligibility decision.

To fill out this application, you will need:

  • Social Security Numbers or document numbers for legal immigrants who need insurance.
  • Dates of birth for each person applying.
  • Employer and income information for each person in the family with income. Use income from the most recent month’s pay stubs or W-2 forms or any document that shows exactly what each person receives as income.
  • Policy numbers for any current health insurance.
  • Information about any job-related health insurance available to your family.

Important Information to Successfully Submit Your Application Form

Apply by completing and submitting a Mississippi Medicaid Application Form (PDF)

To fill out the Mississippi Medicaid Application, please follow the steps below:

  1. Download the Mississippi Medicaid Application form (PDF) to your computer (Application in Spanish)
  2. Open the form and fill out the application with as much information as you can.
  3. Digitally sign the application and date your application.
  4. Select the Submit button at the bottom of the form.

Note: If you open and fill out the application in your browser, the processing of your application may be delayed.

Apply online at
Direct application through Mississippi MedicaidApplication for insurance affordability options and Medicaid, if eligible
Direct application for Mississippi MedicaidApplication is routed through website
Initially handled on a local, state levelInitially handled on a national level


Next steps after applying

For Mississippi Medicaid applications:

  • Applications are reviewed by state staff.
  • Eligibility assessment and determination is approved or denied.
  • If determined applicant is not eligible for Mississippi Medicaid, applications are automatically referred to the FFM.

For applications:

  • Applications are evaluated through the website.
  • Applications are assessed for potential Medicaid eligibility. If potentially eligible, then applications are transferred to the state to determine eligibility.
  • If not potentially eligible for Medicaid, applicants view other insurance affordability program options on

The Division of Medicaid and the FFM will verify as much data as possible from electronic sources in order to verify what is reported on your application. You will only be asked to provide verification of needed eligibility information, if eligibility factors cannot be verified through an available electronic source or if the information you give conflicts with data from electronic sources.

View the income limits for Medicaid and CHIP programs. There is no resource test for any insurance affordability program, including Medicaid and CHIP.

 Fax or Postal Mail

An application form can be printed at either website, completed and submitted to the Division of Medicaid by one of the following ways:

  • Fax the Office of Eligibility at the Division of Medicaid: 601-576-4164
  • Mail to: 550 High Street, Suite 1000, Jackson, MS 39201 or the regional office that serves your county of residence

You may request to have a paper application mailed to you. An original signature is not required for a faxed application.

 In Person

  • Apply in person at one of the 30 regional offices that serves your county of residence.

By Phone

If you want an application mailed to you or if you need telephone assistance:

  • Call the Office of Eligibility toll-free at: 800-421-2408
  • Contact the regional office that serves your county of residence

How to Apply for Aged, Blind or Disabled Medicaid Benefits

If you are applying for aged, blind or disabled Mississippi Medicaid benefits and services, an in-person interview may be required. If so, you will be contacted by staff at the regional office that serves your county of residence.

  • Apply by filling out the Mississippi Medicaid Aged, Blind and Disabled Application Form (Application in Spanish) and submitting the application to the regional office that serves your county of residence or if the applicant is in a nursing home, the regional office that serves the county where the nursing facility is located. Mail or bring in the application at the time of the in-person interview if one is required.  It is advised that you do not email forms or submit online forms with protected health information or personally identifiable information, to protect your confidentiality in accordance with the Health Insurance Portability and Accountability Act of 1996.

How to Apply for Family Planning Benefits

For assistance, call the Office of Eligibility toll-free at 800-421-2408. Submit the application as follows:

Mail: MS Division of Medicaid ATTN: Office of Eligibility
550 High Street, Suite 1000
Jackson, MS 39201-1399

Fax: 601-576-4164

In-Person: at any Medicaid regional office

Voter Registration

To register to vote in Mississippi, click on the form below and complete prior to visiting a Medicaid regional office.

After You Apply