ACA Medicaid/CHIP Referral Notice

The Marketplace Is Not Medicaid — This letter is from the marketplace, but the actual Medicaid decision comes from your STATE Medicaid office, not the marketplace.

What to Expect:

• Your state Medicaid office will contact you (phone, mail, or email)
• They may ask you to complete a separate Medicaid application
• They'll verify your income and eligibility
• You'll receive an approval or denial letter from the state (not the marketplace)

Timeline: This usually takes 2–4 weeks, but can take longer depending on your state's workload.

Watch for mail from your state Medicaid office. They may request:

• Proof of income (pay stubs, tax return)
• Proof of citizenship or legal residency (birth certificate, passport)
• Proof of residence (utility bill)
• Social Security card or number

Important: If Medicaid asks for documents, respond quickly. Delays can mean denial of coverage or loss of the referral.

If Approved for Medicaid:

• You receive a Medicaid approval letter and card
• Coverage typically starts the first day of the month you were approved (or the date you applied, depending on your state)
• You can cancel your marketplace plan if you have one (you're no longer required to pay the premium)
• Medicaid covers doctor visits, hospital, prescription drugs, dental (varies by state), vision (varies by state)

If Denied for Medicaid:

• You receive a denial letter explaining why
• You can appeal the denial if you believe it's wrong
• Your marketplace application is still active — you can enroll in a marketplace plan instead
• You can reapply for Medicaid if your circumstances change (income drops, etc.)

Short Answer: No, don't cancel yet. Wait to see if Medicaid approves you.

Here's Why:

• If Medicaid denies you, your marketplace application is still active
• If you cancel the marketplace application and Medicaid denies you, you'll have to reapply to the marketplace

Timeline: Keep your marketplace application active while you wait for Medicaid's decision. Once you're approved for Medicaid, you can cancel the marketplace plan without penalty.

Short Answer: Technically yes, but you shouldn't.

What the Rules Say: If you're approved for Medicaid, you're not eligible for marketplace tax credits (subsidies). You could buy a marketplace plan at full price, but why would you when Medicaid is free?

Best Practice: Once approved for Medicaid, cancel your marketplace plan and rely solely on Medicaid.

Marketplace Insurance (Even With Subsidies):

• Monthly premium: $50–$300 (after subsidies)
• Deductible: $1,000–$5,000
• Doctor copay: $20–$50
• Out-of-pocket maximum: $5,000–$8,000

Medicaid:

• Monthly premium: FREE (no charge)
• Deductible: Usually $0
• Doctor copay: $0–$5 (usually free or very low)
• Out-of-pocket maximum: Usually $0 or very low

The Difference: Medicaid costs nothing. Marketplace plans always have some cost, even with subsidies. Medicaid is almost always the better deal.

Both Medicaid and Marketplace Insurance Cover:

• Doctor visits
• Hospital care
• Emergency services
• Prescription drugs
• Preventive care (wellness visits, vaccines, screenings)

Services Medicaid Covers That Marketplace May Not:

• Long-term care and nursing home (some states)
• Dental (in most states)
• Vision (in most states)
• Mental health and substance abuse treatment (usually more comprehensive)
• Home health services (in some states)

Bottom Line: Medicaid usually covers everything the marketplace does, PLUS additional services, and costs nothing.