Medicaid & CHIP

Steps if you lost or were denied for Medicaid or CHIP

You may get a notice from us that you or someone in your household isn’t eligible for Medicaid or Children’s Health Insurance Program (CHIP) coverage because at least one person in your household:

  • Applied for Medicaid or CHIP coverage with your state agency and the application was denied.
  • Had Medicaid or CHIP coverage, but recently lost that coverage.
  • Applied for Marketplace coverage and was potentially eligible for Medicaid or CHIP, but was denied by the state.

In these situations, you may still be able to get health coverage through the Marketplace.

What should you do next?

Update your existing Marketplace application or create a new application right away to see if you (or other members of your household) are eligible to buy a Marketplace plan and get help with costs.

  1. Log into your Marketplace account. If you don’t already have a Marketplace account, you can create one.

  2. Update your existing application or create a new one. Get help with your application.

  3. Be sure to include current information about your household income, and also your state’s recent decision about Medicaid and CHIP. (See below for information about answering questions about your eligibility for Medicaid and CHIP.)

  4. Submit your completed application.

  5. Review your results. You'll get eligibility results right away and information about:

    • Financial help that might be available to help lower your costs
    • Other actions you may need to take to confirm your information
    • Enrollment deadlines
    • Your eligibility results will also tell you if you or anyone in your household qualifies for a Special Enrollment Period, which means you can enroll outside Open Enrollment, or get an earlier coverage start date.

  6. Enroll in a Marketplace plan if you’re eligible. Once you enroll, you’ll need to pay your plan’s premium in order for coverage to start.

More answers

How should I answer application questions that ask about Medicaid and CHIP eligibility for the people in my household?

For each question, you’ll see a box next to each household member’s name. If no one on your application applied for Medicaid or CHIP in the past 5 years, select “None of these people.” If someone was denied Medicaid or CHIP coverage, and if your household’s size or income hasn’t changed since the denial, you should check the box next to that person’s name.

Do check the box for any person who:

  • Lost Medicaid or CHIP in the past 90 days because of a change in state rules
  • Will lose their current Medicaid or CHIP coverage within the next month
  • Was denied Medicaid or CHIP in the past 90 days because their income is too high
  • Was denied Medicaid or CHIP in the past 5 years because of their immigration status
  • Was denied Medicaid or CHIP because of their household type (for example, some states don’t cover adults who aren’t taking care of children)
  • Was denied CHIP in the past 90 days because they need to wait for at least a month before starting CHIP coverage (this is called the CHIP waiting period)

Don’t check the box for any person who:

  • Was denied Medicaid or CHIP in the past 90 days but has had changes in household size or income since the denial (unless they were denied based on immigration status)
  • Was denied Medicaid or CHIP more than 90 days ago (unless they were denied based on immigration status)
  • Applied for Medicaid or CHIP but hasn’t received a response yet
  • Was denied Medicaid or CHIP because of the results of a disability determination or because they have too many assets
  • Was denied Medicaid or CHIP coverage because the applicant didn’t submit all the required paperwork
How should I answer application questions that ask about Medicaid and CHIP eligibility if my household size has increased recently?

If your household income has decreased since your state denied Medicaid or CHIP coverage to someone on your application, you should select “None of these people.” For example, you should select “None of these people” if anyone in your household:

  • Lost a job
  • Had their hours or wages cut at work
  • Stopped getting unemployment benefits or another taxable income source

Note: If your household income has decreased since your state denied Medicaid or CHIP coverage to someone in your household, you may be eligible for new or different coverage and help with costs. For example, you may find out you’re eligible for Medicaid or CHIP programs, even if you weren’t when you first applied with your state agency. Or you may become eligible with financial help with the cost of a Marketplace plan.

How should I answer application questions that ask about Medicaid and CHIP eligibility if my household size has increased recently?

If your household size recently increased, you should select “None of these people.” For example, you should select “None of these people” if you or another household member:

  • Got married
  • Had a baby
  • Adopted a child
  • Became pregnant
  • Started claiming somoen new as a dependant on your tax return

Note: If your household size has increased since your state denied Medicaid or CHIP coverage to someone in your household, you may be eligible for new or different coverage and help with costs. For example, you may find out you’re eligible for Medicaid or CHIP programs, even if you weren’t when you first applied with your state agency. Or you may become eligible with financial help with the cost of a Marketplace plan.

How should I answer the application question that asks if anyone in my household applied for state or Marketplace coverage during a certain period of time?

Check the box next to any household member’s name who applied for health coverage through their state or the Marketplace during the dates listed. (Select "None of these people" if no one on your application applied for coverage during these dates.) When you’re asked the date that each person was denied Medicaid or CHIP coverage, you should enter the date that’s on the notice you got from your state.

What if someone in my household has special health care needs (like a disability or a condition that requires help with daily living activities)?

If you already submitted a Marketplace application and indicated that someone in your household has special health care needs, it’s possible that your state may still be checking to see if that person qualifies for more health care services. When you review your Marketplace application, don't change your earlier answers, unless something changed since you last applied.

If you’re creating an application for the first time, be sure to indicate that someone in your household has special health care needs.

More questions?