Want to know if you are eligible for Medicaid or not? Answer some easy questions and request a Medicaid Eligibility Check.Please enable JavaScript in your browser to complete this form.Is your age over 65 years? *YESNODo you have a disability certified by the doctor? *YESNODo you have a paid off house or car? *YESNOAre you a US citizen? *YESNOHave you been living in USA for 5 years (60 months)? *YESNOYour Name *FirstMiddleLastPhone *Enter Your Date of Birth *Request Eligibility Check