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Revision 24-1; Effective March 1, 2024
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.
HHSC must evaluate the person’s eligibility for Medicaid without requiring a new application.
B-3510 Applications Received from the Marketplace
Revision 24-1; Effective March 1, 2024
The federal Marketplace sends a person’s application information to HHSC through an electronic interface when:
- the Marketplace assessment shows the person may be eligible for Medicaid; or
- the person requests a full eligibility determination for Medicaid.
The electronic transfer of application information is called an account transfer. The account transfer includes information provided by the person on the Marketplace application and information verified by the Marketplace.
The account transfer process generates a PDF application with the information the Marketplace provides. Verifications completed by the Marketplace are included in the Verifications section of the PDF. Like an application from YourTexasBenefits.com, enter applicant information into the appropriate logical unit of work (LUW) following the verification policies. This includes any required documentation about blanks or discrepancies on the PDF application.
B-3520 Verifications Provided by the Marketplace
Revision 24-1; Effective March 1, 2024
Medical Programs
Marketplace account transfer PDFs also include a Verifications section. Enter information from the verification section as follows:
- If the Marketplace verified the person's Social Security number (SSN) or citizenship status using data from the Social Security Administration (SSA), accept the information as Verified by SSA.
- If the Marketplace verified the person's alien status using data from the Department of Homeland Security (DHS), accept the information as Verified by DHS.
- If the Marketplace verified other eligibility criteria, such as income or resources, per HHSC verification policy, accept the information as verified.
All other applicant information must be verified as required by the applicable HHSC verification policy. Do not request additional verification for information verified by the Marketplace per HHSC verification policy.
Related Policy
Documentation and Verification Guide, Appendix XVI