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*Centers for Medicare & Medicaid Services*

*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.

Centers for Medicare & Medicaid Services (CMS) has sent this update. To contact Centers for Medicare & Medicaid Services (CMS) go to our *contact us [ http://www.cms.gov/About-CMS/Agency-Information/ContactCMS/index.html ] *page.


* FAQs Consumers the FFM Refers to Medicaid and CHIP Agencies.pdf [ https://content.govdelivery.com/attachments/USCMS/2025/01/17/file_attachments/3136907/FAQs%20Consumers%20the%20FFM%20Refers%20to%20Medicaid%20and%20CHIP%20Agencies.pdf ]

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