Once you get a final determination that you're eligible for Medicaid or the Children’s Health Insurance Program (CHIP) that counts as qualifying health coverage (or "minimum essential coverage"):
Note: Most programs through Medicaid and CHIP count as qualifying health coverage under the health care law. If your Medicaid program doesn't count as qualifying health coverage, you may be eligible for advance payments of the premium tax credit and other savings on a Marketplace health plan, if you qualify based on your income and other factors. Find out if your Medicaid program counts as qualifying health coverage.
Important: Make sure you're eligible
Don’t end your Marketplace plan before you get a final decision of your Medicaid or CHIP eligibility. If you’re found ineligible for Medicaid or CHIP, you can’t re-enroll in the Marketplace plan unless you qualify for a Special Enrollment Period. You’d have to wait for the next Open Enrollment Period and may have a gap in coverage.End highlighted text
If our records show you’re enrolled in both a Marketplace plan with premium tax credits or other cost savings and Medicaid or CHIP — something we check a few times a year — you may get a notice in the mail that lists the household members who are enrolled in both kinds of coverage. The notice explains what to do next.
Take action within 30 days
Update your Marketplace application to show you’re not enrolled in Medicaid or CHIP, or end your Marketplace coverage with premium tax credits or other cost savings by the date indicated on your initial warning notice (within 30 days from the date of the notice).
If you don’t take action:
If you want more information about Medicaid or CHIP, or if you aren’t sure if you or others in your household are enrolled in Medicaid or CHIP, you can contact the office in your state:
You can have both a Marketplace plan and Medicaid or CHIP, but you’re not eligible to receive advance payments of the premium tax credit or other cost savings to help pay for your share of the Marketplace plan premium and covered services. If you or others on your Marketplace application choose to have Medicaid or CHIP and full-price Marketplace coverage:
Answer a few questions for step-by-step instructions on how and when to end your Marketplace plan with premium tax credits and other cost savings.
Some limited types of Medicaid coverage pay only for:
If you have limited-benefit Medicaid coverage, you can apply for coverage through the Marketplace to get comprehensive coverage in addition to your limited-benefit Medicaid coverage. Because this type of Medicaid is not considered qualifying health coverage, you may qualify for lower costs on your monthly premiums and extra savings on out-of-pocket costs for a Marketplace plan, depending on your household size and income.
Important: If you have limited-benefit Medicaid coverage, when you fill out a Marketplace application and are asked whether you have coverage now, don’t check the box saying you have Medicaid. Check “None of the above” instead.
Note for current Marketplace enrollees: If you are enrolled in Marketplace coverage with premium tax credits or other cost savings, you don’t have to end your Marketplace plan to enroll in limited-benefit Medicaid. That’s because limited-benefit Medicaid isn’t considered qualifying health coverage. You can apply for this coverage directly to your state Medicaid agency.
If you’re not enrolled in Medicaid or the Children's Health Insurance Program (CHIP), and got a notice that you may lose financial help for your Marketplace coverage because of enrollment in one of these programs, you need to tell the Marketplace you’re not enrolled in Medicaid or CHIP by updating your application. If you don’t, you’ll pay more for your monthly premiums because your advance payments of the premium tax credit and cost-sharing reductions (if applicable) will end.
To update your application: