If a consumer receives a Medicaid/CHIP PDM notice and takes no action, what happens to financial assistance?

If a consumer receives a Medicaid/CHIP PDM notice and takes no action, what happens to financial assistance?

• A. The consumer will lose financial assistance (APTC and/or CSRs) and pay the full premium.
• B. The consumer will automatically stay on the same plan with subsidies.
• C. The consumer will be enrolled in Medicaid automatically.
• D. The consumer will receive a penalty.

Answer: (A)

A Medicaid/CHIP determination takes precedence over marketplace subsidies. When you receive a Medicaid/CHIP PDM notice, it means you may be eligible for Medicaid or CHIP, and the system prompts you to apply or act within a set window. If you do not take action, you’re considered not enrolling in Medicaid/CHIP, and the marketplace stops your premium subsidies. That means you lose the APTC and any CSRs you were receiving and must pay the full premium for your plan. In short, subsidies disappear because you’re no longer eligible for them once Medicaid/CHIP eligibility is unresolved or established, so you’d cover the plan’s full cost.

A Medicaid/CHIP determination takes precedence over marketplace subsidies. When you receive a Medicaid/CHIP PDM notice, it means you may be eligible for Medicaid or CHIP, and the system prompts you to apply or act within a set window. If you do not take action, you’re considered not enrolling in Medicaid/CHIP, and the marketplace stops your premium subsidies. That means you lose the APTC and any CSRs you were receiving and must pay the full premium for your plan. In short, subsidies disappear because you’re no longer eligible for them once Medicaid/CHIP eligibility is unresolved or established, so you’d cover the plan’s full cost.