B-3500, Coordination with the Federal Marketplace

Revision 25-2; Effective June 1, 2025

Eligibility determinations for Medicaid must be coordinated with the federal Marketplace . A person who applies for health care coverage through the Marketplace at HealthCare.gov is also assessed for Medicaid eligibility. If the Marketplace assessment does not show the person may be eligible for Medicaid, the person can still request their information be transferred to HHSC for a full eligibility determination.

The Marketplace assesses a person as:

potentially eligible for Medicaid based on Modified Adjusted Gross Income (MAGI) rules; or

potentially eligible for Medicaid on a non-MAGI basis if the person is 65 or older or reports having a disability or blindness.

If the assessment shows the person may be eligible for Medicaid, the person’s application information is transferred to HHSC.

For non-MAGI account transfers, evaluate the person’s eligibility for Medicaid and the Medicare Savings Program (MSP) without requiring a new application.