Frequently Asked Questions for Consumers Whom the Federally-facilitated Marketplace or State-based Marketplaces on the Federal Platform Refers to a State Medicaid/Children’s Health Insurance Program (CHIP) Agency (SMA) and Who are Awaiting a Final Medicaid or CHIP Eligibility Determination from their SMA

The FAQ applies to consumers who were referred by the Marketplace as potentially eligible for Modified Adjusted Gross Income (MAGI)-based Medicaid/CHIP and were referred to their SMA, and who are waiting for their SMA to conduct a final MAGI-based Medicaid/CHIP eligibility determination. This can occur in households where all applicants are found by the Marketplace as potentially eligible for Medicaid/CHIP or in households where some applicants are found eligible for Marketplace coverage and others are potentially Medicaid/CHIP-eligible. Households in the latter scenario will have qualified health plan (QHP)-eligible applicants routed to enroll in coverage with the Marketplace, and applicants assessed as Medicaid/CHIP-eligible will have their application information securely electronically transferred to their SMA for final eligibility determinations and/or enrollment, if eligible. The FAQ can be used to assist consumers navigating these various scenarios.