The Navigator Resource Guide has not been updated for 2025 Open Enrollment. For more current information please visit:
cms.gov/marketplace/in-person-assisters/information-partners.
QUESTION

When I projected my income for next year I was determined eligible for Medicaid. When I submitted my application for Medicaid to my state’s Medicaid agency, I was told my income was too high. How do I get enrolled in coverage?

Individuals with no coverage | Eligibility for Premium Tax Credits and Cost-Sharing Reductions | How Premium Tax Credits And Cost-Sharing Reductions Work |
ANSWER

If you are denied coverage under Medicaid, you can come back to your Marketplace application and attest that you received a Medicaid denial. You should then be reconsidered for Marketplace coverage and financial assistance. If you are denied Marketplace financial assistance because your income is below 138 percent of the federal poverty level, you should contact the state Medicaid agency for a review of your application and appeal any denial of coverage. If you live in a state that has not expanded Medicaid and your income is below 100 percent of the federal poverty level, you may not be eligible for subsidized coverage in either program unless you qualify for Medicaid as a low-income parent with dependent children (see our state fact sheets for details on eligibility for parent/caretakers in Medicaid). (42 C.F.R. § 435.603(h)(3),(i).)

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