Question of the Day:
Does a rise in income above the poverty line trigger a special enrollment period for a consumer who did not qualify for Medicaid due to her state’s decision not to expand Medicaid?

The Health Care Assister’s Guide to Tax Rules

From the Center on Budget and Policy Priorities

The health reform law changed the way Medicaid and CHIP determine eligibility for most beneficiaries to align with how eligibility for premium tax credits is determined in the marketplaces.  All three coverage programs determine a household’s size and income using tax rules.  The Center developed The Health Care Assister’s Guide to Tax Rules to familiarize people who are helping consumers apply for Medicaid, CHIP and premium tax credits with the tax rules that are applied in determining eligibility for these programs.

The guide explains the basics of who must file taxes, different filing status options, rules for claiming tax dependents, rules for determining Medicaid and CHIP households and how these rules differ from rules for premium tax credit, as well as what sources of income are considered taxable and therefore counted in determining Medicaid and premium tax credit eligibility.  The guide is meant to give health care assisters a basic understanding of these rules to help guide discussions with applicants.

Resolving Inconsistencies Resource

From the Center on Budget and Policy Priorities.


Starting in late July or early August, subsidies could be reduced or terminated for hundreds of thousands of consumers who enrolled in health coverage through  To avoid having their subsidies go down or end, consumers must send in documents to verify their income and/or citizenship or immigration status.  Navigators, certified application counselors and others helping consumers with eligibility and enrollment in states using the Federally Facilitated Marketplace (FFM) can play a critical role in ensuring that consumers can maintain their coverage.

Click here for more information on the issue, and to find out how you can help.