My income qualifies for Medicaid, but I can't get Medicaid or an ACA plan? Why?

January 16, 2014

How the Medicaid Expansion affects you 


The Affordable Care Act called for the expansion of Medicaid - a program which offers free or low-cost healthcare to low income individuals and families - to include more people.


But Medicaid is run on a state level, and not every state chose to expand the program. If your state didn't expand Medicaid, your options might be more limited.


Medicaid eligibility rules vary by state as well. So even if your income qualifies you for the program, you might not get benefits in your state. For example, some states only offer Medcaid to low-income individuals who are children, pregnant women, elderly, or who have disabilities. If you don't fall into one of those categories in that particular state, you won't get Medicaid health coverage even though your income level qualifies. 



I applied through the Federal Marketplace, but was declined for Medicaid and ACA. Why?


If you applied for a Marketplace plan, and were instructed to apply for Medicaid - but you didn't get either one - it's probably because your state didn't expand Medicaid. 


If your income level is at or below 100% of Federal Poverty Level, and your state didn't expand Medicaid, you cannot qualify for a tax subsidy under ACA.


And based on your states eligibility rules, you might not be able to get Medicaid, either. 


That could potentially leave you without a single affordable healthcare option. You are the gap in the law.



Qualifying for an exemption from the penalty for not having health insurance


If you don't have access to an affordable health insurance option, you might qualify for an exemption from the Individual Mandate. Starting in 2014, we are required to have health insurance or pay a penalty, unless we qualify for an excemption. 


Read about how to qualify for an exemption letter here

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