Q&A: Differences Between Marketplace and Medicaid MAGI

Executive Summary

This Q&A outlines a common error made by states when determining eligibility under Modified Adjusted Gross Income (MAGI), leading to unlawful Medicaid denials. MAGI rules differ for Marketplace and Medicaid eligibility determinations. Because of those differences, there may be instances in which an individual seemingly is financially ineligible for both programs. Federal MAGI regulations ensure an individual is not left without any coverage. This NHeLP resource distinguishes the differences and navigates the process.

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