Denied Medicaid for Being “Over-Income”? It’s Not the End of the Road. It’s a Detour.

My name is Alex, and for the last fifteen years, I’ve worked as a benefits navigator.

My job is to help people make sense of the tangled web of public assistance programs.

I’ve seen it all, but one story, one phone call, changed the way I see everything.

It was about a client I’ll call Maria.

She was a single mother of two, working a tough job in retail.

After months of coaching and preparation, she finally secured a promotion—and a raise of $2 an hour.

We celebrated.

It wasn’t a lottery win, but it felt like one.

It was a step up, a breath of fresh air, a validation of her hard work.

A few weeks later, she called me, but she wasn’t celebrating.

She was in tears, her voice cracking with a mix of anger and confusion.

She was holding a letter from the state.

Her family’s Medicaid coverage had been terminated.

That $2-an-hour raise, the one that was supposed to be her foothold on the ladder to stability, had pushed her monthly income just a few hundred dollars over her state’s rigid limit.

She had fallen off the “Medicaid cliff”.¹

In that moment, I felt a profound sense of failure.

The system I was supposed to help people navigate had just punished a woman for doing everything right.

It felt like a cruel joke, a dead end.

For days, I was stuck on that feeling of frustration.

I kept picturing Maria, standing at the edge of that cliff, with nowhere to go.

And then, it hit me.

My mistake—and the mistake so many of us make—was seeing the system as a single road that ended at a cliff.

I was looking at a single destination instead of the entire landscape.

The real system isn’t a road; it’s a transit map.

Imagine the public transit system of a major city.

There are express subway lines, local buses, special shuttles for people with disabilities, and even free circulator routes downtown.

Medicaid is just one line on that map—a vital one, but still just one.

A denial letter isn’t a sign that you’re stranded.

It’s a notification that your usual route is closed for you right now, and you need to find a transfer point.

My mission since that day has been to give my clients a copy of that map.

I’m not just a navigator anymore; I’m a transit planner.

And today, I’m going to give that map to you.

We’re going to look at your denial letter not as an ending, but as your starting point.

We’ll trace the main lines, find the express routes with discounted fares, map out the local safety nets, and I’ll show you how to get where you need to go: to affordable, quality healthcare for you and your family.

Part 1: Reading the Map – Why “Over-Income” Happens and What It Really Means

Before you can plan a new route, you have to understand exactly where you are on the map.

That denial letter, as cold and bureaucratic as it feels, is your “You Are Here” sticker.

Let’s break down the language so you can understand what it’s actually telling you.

Deconstructing the Denial Letter: Your Starting Point on the Map

When a letter says you are “over-income,” it’s using a specific language based on three key ingredients: the Federal Poverty Level, your specific income calculation, and your household size.

1. The Federal Poverty Level (FPL): The Map’s Topography

The Federal Poverty Level, or FPL, is the baseline measurement used by the government to determine who is eligible for a huge range of federal programs, including Medicaid.²

Think of it as the “sea level” for financial need in the country.

Each year, the Department of Health and Human Services sets income thresholds for different household sizes.

For example, in 2024, 100% of the FPL for a single person was $15,060 per year, and for a family of three, it was $25,820 per year.²

Most program eligibility limits are expressed as a percentage of this level, like

138% FPL or 250% FPL.

Table 1: 2024 Federal Poverty Level (FPL) Guidelines

Household Size	100% FPL (Yearly Income)
1	$15,060
2	$20,440
3	$25,820
4	$31,200
5	$36,580
6	$41,960
7	$47,340
8	$52,720

Source: Data from Healthcare.Gov.²

For families/households with more than 8 people, add $5,380 for each additional person.

2. Modified Adjusted Gross Income (MAGI): How They Count Your Money

This is one of the most common points of confusion.

Medicaid doesn’t look at your take-home pay.

It uses a specific calculation called Modified Adjusted Gross Income, or MAGI.³

This is a method established by the Affordable Care Act to create a standardized way of counting income across different programs.

MAGI generally includes:

• Wages, salaries, and tips
• Taxable interest
• Unemployment compensation
• Social Security benefits ⁴

It does not typically include things like child support payments, Supplemental Security Income (SSI), or veterans’ disability payments.

It’s crucial to understand that your MAGI might be higher than you think, which can be the specific reason you’ve been pushed over the income limit.⁶

3. Household Size: Who’s on the Journey With You

The FPL income limits are tied directly to the number of people in your household.

But how Medicaid defines a “household” can be tricky.

It’s generally based on your tax filing status.

It includes the tax filer, their spouse, and anyone they claim as a tax dependent.⁷

Getting this number wrong on your application is a simple mistake that can lead to a denial.

The Two Americas of Medicaid: Why Your State’s “Map” is Different

Now we come to the single most important detail on your map: the state you live in.

The Affordable Care Act (ACA) intended to expand Medicaid to cover nearly all adults with incomes up to 138% of the FPL.⁸

However, a 2012 Supreme Court ruling made this expansion optional for states.⁹

This decision effectively split the country in two, creating vastly different transit maps for residents.

Expansion States: A Seamless Transfer

As of early 2024, 41 states and Washington d+.C.

have adopted Medicaid expansion.¹⁰

In these states, the system works more or less as intended.

If you are an adult earning up to

138% of the FPL (about $20,782 for an individual or $35,631 for a family of three in 2024), you are eligible for Medicaid.¹¹

If your income is above that, you can seamlessly “transfer” to the ACA Marketplace, where you will likely qualify for financial assistance.

The connection between these two major programs is strong.

Non-Expansion States: The Transit Desert

In the 10 states that have not expanded Medicaid, the map is broken.¹²

These states chose to stick with their pre-ACA eligibility rules, which are often incredibly strict and were designed primarily for specific groups like pregnant women, children, seniors, or people with disabilities—not for able-bodied, low-income adults.¹¹

The income limits in these states are shockingly low.

For a parent in a family of three, the median eligibility limit is just 38% of the FPL.⁹

In Texas, one of the strictest states, the limit for parents is a mere

16% of the FPL.¹³

This means a parent in Texas could earn more than about $350 a month and be considered “over-income” for Medicaid.

This creates a devastating situation known as the Medicaid Coverage Gap.

The Coverage Gap Explained: This is the cruelest part of the map, a place where you are stranded.

You are in the coverage gap if you earn too much to qualify for your state’s incredibly strict Medicaid program, but too little to qualify for financial help on the ACA Marketplace.¹

The ACA subsidies were designed to start at 100% of the FPL, because the law assumed everyone with income below that level would be covered by expanded Medicaid.⁹

When states didn’t expand, they created a chasm.

An estimated 1.9 million Americans are currently stuck in this gap, with people of color and childless adults disproportionately affected.⁹

The reason for your denial isn’t just about your personal finances; it’s a direct result of your state’s political geography.

A small raise that leads to a devastating loss of coverage in one state might be a complete non-issue in another.

This isn’t a personal failure; it’s a systemic one.

Understanding this context is the first step toward reclaiming your power.

You didn’t fail the system; the system’s map has a giant hole in it where you happen to live.

Table 2: The Medicaid Cliff – A Tale of Two States (2024 Example)

State	Medicaid Expansion Status	Monthly Income Limit for a Parent in a Family of 3 (Approximate)	FPL Equivalent
Virginia	Yes (Expanded)	$3,065 16	~138%
Texas	No (Not Expanded)	$331 9	~16%

This table dramatically illustrates how a person in Texas can be denied Medicaid for earning what would be considered deep poverty in Virginia, a state that expanded its program.

Finally, remember that the system’s sheer complexity is a major barrier.

Up to 75% of all Medicaid denials are due to procedural issues like missing paperwork or lost documents, not because the applicant is truly ineligible.⁶

People get caught in bureaucratic nightmares, like Catherine St. Clair, who fought for months after her sister’s essential care was denied based on illogical reasoning, or Takesha, who lost her family’s coverage because the agency lost her electric bill.¹⁸

Your very first step after a denial should be to call your state agency and confirm the

exact reason.

It may be a simple, fixable error.

Part 2: The Main Transit Lines – Your Guide to the ACA Marketplace

If you’ve confirmed your denial was due to income and you live in a Medicaid expansion state (or if you live in a non-expansion state but your income is above 100% FPL), your next stop is the main transit hub: the Health Insurance Marketplace, which you can access at HealthCare.Gov.²⁰

Think of this as the central subway system designed to get most people where they need to go.

Losing your Medicaid coverage is considered a Qualifying Life Event (QLE).

This is incredibly important because it opens up a Special Enrollment Period (SEP) for you.²¹

You typically have 60 days from the date your Medicaid coverage ends to enroll in a Marketplace plan.

Don’t wait—you can and should apply as soon as you receive your termination notice to avoid any gap in coverage.²²

Decoding the “Metal Tiers”: Choosing Your Ride

When you shop on the Marketplace, you’ll see plans organized into four “metal” tiers: Bronze, Silver, Gold, and Platinum.

These names have nothing to do with the quality of care; they are simply a shorthand for how you and your insurance plan will split the costs of your healthcare.²³

• Bronze Plans: These are like a low-fare ticket that mainly covers you for big emergencies. They have the lowest monthly premiums but the highest out-of-pocket costs (deductibles, copays) when you need care.²⁵ If you’re generally healthy and just want protection from a catastrophic medical event, a Bronze plan might be a good fit. You’ll typically pay about 40% of your medical costs, while the plan pays 60%.²⁴
• Silver Plans: These are the “benchmark” plans with moderate monthly premiums and moderate out-of-pocket costs.²⁵ The plan pays about 70% of costs, and you pay 30%. As we’ll see in a moment, Silver plans have a hidden superpower that makes them the most important and often the best-value choice for low- to moderate-income individuals.²⁴
• Gold & Platinum Plans: These are like a premium monthly pass. They have the highest monthly premiums but the lowest out-of-pocket costs when you get care.²⁵ If you know you’ll need frequent medical services or take expensive prescription drugs, a Gold (plan pays 80%) or Platinum (plan pays 90%) plan could save you money in the long run despite the higher upfront cost.²⁴

The Financial Lifelines: Your “Transit Pass Discounts”

This is the most important part of navigating the Marketplace.

For most people, the sticker price of these plans is unaffordable.

But very few people pay the sticker price.

The ACA created two types of subsidies, or discounts, to make coverage affordable.

1. The Advance Premium Tax Credit (APTC)

This is the main subsidy that helps with your monthly bill.

The APTC is a tax credit that you can use right away to lower your monthly premium.²⁷

Instead of waiting to get it when you file your taxes, the government sends it directly to your insurance company each month.

You are generally eligible for an APTC if your household income is between 100% and 400% of the FPL.²⁸

(Thanks to the Inflation Reduction Act, this

400% cap has been temporarily removed, meaning more people can get help).

The amount of your credit is calculated to ensure you don’t have to pay more than a certain percentage of your income (from 0% to 8.5%) for a “benchmark” Silver plan.²⁸

You can then take that credit and apply it to any metal tier plan you choose—Bronze, Silver, Gold, or Platinum.²⁸

For many, this can result in a plan with a $0 monthly premium.²³

2. Cost-Sharing Reductions (CSRs)

This is the secret superpower I mentioned.

CSRs are extra savings that lower your out-of-pocket costs, like your deductible, copayments, and coinsurance.²⁷

This means you pay less every time you actually go to the doctor or fill a prescription.

Here is the critical rule: You can only get these powerful extra savings if you meet two conditions:

1. Your income is between 100% and 250% of the FPL.
2. You enroll in a Silver plan.²⁴

If you qualify, a CSR-enhanced Silver plan can be an incredible deal.

It can transform a standard Silver plan (where the insurer pays 70% of costs) into one that functions like a Gold or even a Platinum plan, with the insurer covering up to 94% of your costs, but you still pay the lower Silver-level premium.²⁴

For anyone in this income bracket, a Silver plan is almost always the best choice.

The way these subsidies interact creates a fascinating and powerful quirk in the system that many people Miss. Because insurers are required to offer CSR discounts but the federal government no longer reimburses them for it, many states allowed insurers to add the cost of CSRs exclusively to the premiums of Silver plans.

This practice, known as “silver loading,” makes unsubsidized Silver plans look artificially expensive.²⁹

However, this creates an opportunity.

The size of your APTC subsidy is tied to the price of that benchmark Silver plan.

When the Silver plan’s premium is inflated, your subsidy gets bigger.

You can then take that larger-than-normal subsidy and apply it to a different plan.

This can make Bronze plans incredibly cheap (often free) or make Gold plans much more affordable than they would otherwise be.

It’s a counter-intuitive market dynamic, but for a savvy shopper, it means you can potentially get a Gold-level plan for a Silver-level price.

This is why it is absolutely essential to compare all your options on the Marketplace after entering your income information.

Table 3: ACA Metal Tiers & Subsidies at a Glance

Metal Tier	Plan Pays (on average)	You Pay (on average)	Typical Premium	Typical Deductible	Who It’s Good For	Key Subsidy
Bronze	60%	40%	Lowest	Highest	Healthy individuals needing catastrophic protection.	APTC
Silver	70%	30%	Moderate	Moderate	Anyone with income from 100%−250% FPL.	APTC + CSR
Silver (with CSR)	73%−94%	6%−27%	Moderate	Low	The best value for eligible individuals.	APTC + CSR
Gold	80%	20%	High	Low	People who expect to use medical services often.	APTC
Platinum	90%	10%	Highest	Lowest	People with significant, ongoing health needs.	APTC

Source: Data compiled from HealthCare.gov, UHC.com, and KFF.org.²³

Part 3: The Special Shuttles – How to Get Back on the Medicaid Line

What if an ACA plan, even with subsidies, is still out of reach? Or what if your income is just barely over the Medicaid limit and you have very high medical needs? For these specific situations, our transit map has a few “special shuttle” routes designed to get you back to the main Medicaid line.

These options are more complex and aren’t for everyone, but for the right person, they are a lifeline.

The Medicaid Spend-Down Program: Using Medical Bills as Your “Fare”

The Medicaid Spend-Down program is one of the most misunderstood but powerful tools available in many states.

It’s designed for people who are “medically needy”—meaning they meet all of Medicaid’s non-financial requirements but their income is too high.⁵

How It Works: A Simple Analogy

Think of the Spend-Down program like an insurance deductible for your income.

The state calculates the difference between your monthly income and the state’s Medicaid income limit.

This difference is your “spend-down liability”.³¹

You are responsible for paying for your own medical care up to that amount each “spend-down period” (which can be one to six months, depending on the state).

Once you can show the Medicaid office that you have incurred medical bills that equal your spend-down liability, Medicaid activates and covers your approved medical costs for the rest of the period.³⁰

A Practical Example:

• Let’s say your state’s Medically Needy Income Limit (MNIL) is $1,000 per month.
• Your monthly income is $1,300.
• Your spend-down liability is the difference: $1,300 – $1,000 = $300 per month.
• In the first week of the month, you visit a specialist and get a bill for $500.
• You submit that $500 bill to your Medicaid caseworker. You have now “met” your $300 spend-down.
• You are responsible for paying the first $300 of that bill. Medicaid will then pay the remaining $200 and cover your other approved medical expenses for the rest of the month.⁵

What Counts as a “Medical Bill”?

A wide range of expenses can be used to meet your spend-down, including ³¹:

• Paid and unpaid bills from doctors, hospitals, and dentists.
• The cost of prescription drugs and certain medical supplies.
• Health insurance premiums you pay (including for Medicare or an ACA plan).
• In-home care costs.
• Transportation to medical appointments.

You can even use old, unpaid medical bills to meet your spend-down for the current period.³³

It’s essential to keep meticulous records—copies of every bill and receipt—to provide to your caseworker.³¹

Some states also offer a “Pay-In” option, where you can simply pay your spend-down amount directly to the state each month to activate your coverage.³³

The Qualified Income Trust (QIT): A “Holding Account” for Your Income

This second shuttle route is even more specialized.

A Qualified Income Trust (QIT), also known as a “Miller Trust,” is a legal tool used almost exclusively by individuals who need a high level of long-term care (like in a nursing facility or extensive home care) but whose income is over the Medicaid limit for those services.⁶

How It Works: A Simple Analogy

A QIT is like a special, state-approved “locked box” for your income.

Each month, you deposit the portion of your income that is over the Medicaid limit into a dedicated bank account that is part of the trust.³⁵

For the purposes of determining your Medicaid eligibility, the money inside that box becomes invisible.

By placing your “excess” income into the trust, your remaining, “countable” income now falls below the Medicaid limit, allowing you to qualify.

There are very strict rules for a QIT ³⁵:

• It’s Irrevocable: You can’t just change your mind and dissolve it.
• It Needs a Trustee: Someone other than you must be appointed to manage the trust and pay bills from it.
• It’s for Income Only: You cannot deposit assets or resources (like money from selling a house) into a QIT.
• The State is the Beneficiary: Upon the death of the Medicaid recipient, any money left in the trust must first be used to repay the state for the cost of the Medicaid benefits it provided.

These tools are not proactive solutions for everyday health coverage.

They are reactive mechanisms designed for people with significant, ongoing, and often expensive health needs.

If you are relatively healthy and just need coverage for check-ups and potential illnesses, the ACA Marketplace is almost certainly your better route.

But if you find yourself facing overwhelming medical bills or the need for long-term care, these special shuttles can be the only way to get back on the Medicaid line.

Part 4: The Local Network – Your Community Safety Nets

For those of you stranded in the Coverage Gap in a non-expansion state, or for anyone who finds that even a subsidized ACA plan is unaffordable, the map has one more critical network: the local routes.

These are the community-based organizations that serve as the ultimate safety net, providing care when all other doors seem closed.

Care That’s Always There: Community Health Centers

If there is one resource I want every single person reading this to know about, it’s Community Health Centers.

Also known as Federally Qualified Health Centers (FQHCs), these are community-based clinics that receive federal funding with a clear mandate: to provide comprehensive primary care in underserved areas.³⁶

Here’s what makes them so vital:

• They Serve Everyone: This is the most important point. FQHCs provide care to all patients, regardless of their income or insurance status.³⁹ You cannot be turned away because you can’t pay.
• They Use a Sliding-Fee Scale: This is their core feature. The amount you pay for a visit is based directly on your household income and family size.³⁷ For those with very low incomes, care can be extremely low-cost or even free.
• They are Comprehensive: These aren’t just walk-in clinics for a cold. Many FQHCs are true medical homes, offering a wide range of services under one roof: primary medical care, dental services, mental and behavioral health, women’s health, pediatrics, and often have on-site pharmacies with discounted medications.³⁹
• They are Easy to Find: The federal government’s Health Resources and Services Administration (HRSA) maintains an easy-to-use online tool to find a health center near you. Simply enter your address, and it will show you the locations on a map.

For someone in the Coverage Gap, an FQHC can be their only source of consistent, affordable primary care.

They are the bedrock of the healthcare safety Net.

How to Find a Community Health Center:

Visit the HRSA “Find a Health Center” website at findahealthcenter.hrsa.gov.43

When Hospital Bills Strike: Unlocking Charity Care

A trip to the emergency room or a hospital stay can be financially catastrophic for anyone, but especially for someone without adequate insurance.

This is where another underutilized safety net comes in: Hospital Charity Care.

Under federal law, as a condition of their tax-exempt status, all non-profit hospitals must have a financial assistance policy, often called “Charity Care”.⁷

This is not optional.

Here’s the critical information you need to know:

• It’s Not Just for the Uninsured: This is a common misconception. Charity Care can be used to help with your out-of-pocket costs—like high deductibles and copayments—even if you have insurance.⁷ If you have a high-deductible Bronze plan from the Marketplace and end up in the hospital, you can and should apply for Charity Care to help cover that deductible.
• Eligibility is Broader Than You Think: Eligibility is based on income, and the thresholds are often surprisingly high. Many hospital policies provide free care for patients with incomes up to 200% of the FPL and significant discounts for those with incomes up to 400% of the FPL.⁴⁵ A family of four earning up to $124,800 a year could potentially qualify for discounted care at some hospitals.⁴⁵
• You Have Rights: Hospitals are required to make their financial assistance policies public and easy to find. They must give you at least 240 days from the date of your first bill to apply for assistance.⁷

How to Apply for Charity Care: A 5-Step Guide

Navigating this can feel intimidating, but the process is straightforward if you follow these steps ⁷:

1. Ask for the Policy and Application. Call the hospital’s billing or financial assistance department and ask for a copy of their Financial Assistance Policy and the application form. They are required to provide it. You can also usually find it on the hospital’s website.
2. Gather Your Documents. You will need to provide proof of your income. This typically includes recent pay stubs, your most recent tax return, and letters for any other income like Social Security or unemployment.⁷
3. Submit the Application. Fill out the application completely and attach copies of all your documents. Send it to the hospital according to their instructions (mail, fax, or in-person). Always keep a copy of everything you send for your own records.
4. Follow Up Persistently. Call the hospital a week after you submit the application to confirm they received it. Continue to call periodically to check on the status. Be polite but persistent.
5. Appeal if Denied. If your application is denied, the hospital must tell you why in writing. You have the right to appeal their decision. Often, a denial is due to a missing document that you can still provide.

These local safety nets are designed to catch you.

The ACA plan might be your primary vehicle, but Charity Care is the seatbelt and airbag that can protect you from financial ruin in a crash.

For those in the Coverage Gap, FQHCs and Charity Care aren’t just a backup plan; they are the plan.

Part 5: Risky Shortcuts and Dead Ends – A Word of Warning

On your journey to find coverage, you will inevitably see advertisements for plans that seem too good to be true.

They promise low monthly premiums and immediate coverage.

These are typically short-term, limited-duration health insurance plans, and I need to be very clear: these are not a safe route.

They are a risky shortcut that often leads to a financial dead end.

The Lure of “Cheap” Coverage: Short-Term Health Insurance

These plans are appealing because their premiums are often a fraction of the cost of an ACA-compliant plan.⁴⁶

But there is a very good reason they are so cheap.

Unlike plans on the Marketplace, short-term plans are not required to follow the rules of the Affordable Care Act.⁴⁸

They operate in a sort of regulatory Wild West, and that puts all the risk squarely on your shoulders.

The Hidden Dangers: Why the Fare is So Low

The low price of a short-term plan is not a sign of efficiency; it’s a sign of what’s missing.

Here are the biggest dangers:

• They Do NOT Cover Pre-existing Conditions: This is the single greatest risk. A short-term plan can refuse to sell you a policy if you have a health condition. Even if they do sell you a policy, they can (and will) refuse to pay for any care related to a condition they determine was “pre-existing”.⁴⁶ This could be anything from diabetes to a bad back you had treated two years ago. An estimated 27% of American adults have a declinable pre-existing condition, making them ineligible from the start.⁴⁷
• They Do NOT Cover Essential Health Benefits: ACA plans are required to cover ten essential health benefits. Short-term plans are not. This means they often exclude or provide very limited coverage for critical services like prescription drugs, maternity care, mental health services, and substance abuse treatment.⁴⁶
• They Have Coverage Caps: Many of these plans have annual or even lifetime dollar limits on what they will pay.⁴⁶ If you have a serious accident or illness, you could easily blow past a $250,000 cap and be responsible for every dollar of care after that. ACA plans are prohibited from having such caps.
• They Can Just Say No: Because they use medical underwriting, insurers can review your health history and simply deny your application for any reason.⁴⁶

These plans are not a type of health insurance in the same way an ACA plan Is. A true insurance plan is about pooling and managing risk.

A short-term plan is designed to avoid risk by screening out anyone who might actually need to use their health insurance.

They are a financial product that creates, rather than mitigates, the risk of catastrophic medical debt.

Please, for your financial and physical health, stay on the main roads and avoid this dangerous shortcut.

Conclusion: Becoming Your Own Best Navigator

Let me end with another story.

A client I’ll call David, a self-employed carpenter in his 50s living in a non-expansion state, came to me after a Medicaid denial.

He was in the Coverage Gap.

He was healthy but terrified of what one fall from a ladder could do to his life’s savings.

The sticker price for an ACA plan was too high.

He felt completely lost.

So, we pulled out the transit map.

First, we looked at the “local network.” We found a Community Health Center (FQHC) just a few miles from his house.

He made an appointment, established care, and now has a medical home where he can go for check-ups and primary care on a sliding-fee scale.

That was his local bus route for everyday needs.

Next, for catastrophic protection, we went back to the ACA Marketplace.

We found a high-deductible Bronze plan.

The premium was still a stretch, but it was manageable.

This was his “express line” in case of a true emergency.

Finally, we did our homework.

We downloaded the Charity Care policy and application from his local non-profit hospital.

We filled it out and put it in a folder with his financial documents.

He hasn’t needed it, but he knows that if he ever has that fall, he has his application ready to go to help with the high deductible.

He has a multi-layered, affordable plan that he understands and controls.

David became his own best navigator.

And you can, too.

A denial letter feels like a judgment.

It feels like a door slamming shut.

But it is not a final destination.

It is a signpost, a “route closed” sign that is pointing you toward a different path.

Your Personalized Action Plan: The “Trip Planner”

When you get that letter, don’t panic.

Pull out your map and follow these steps:

1. Verify the Reason: Call your state Medicaid agency. Is your denial truly because of income, or was it a paperwork error?⁶ If it was an error, ask how you can fix it and reapply.
2. Check Your State’s Map: Are you in one of the 41 expansion states or one of the 10 non-expansion states?¹⁰ Your location determines your primary options.
3. Explore the ACA Marketplace (HealthCare.gov): This is your most important next stop. Get a real quote based on your income to see what your premiums would be with subsidies. Pay special attention to Silver plans if your income is below 250% FPL.²²
4. Investigate the Special Shuttles: If your income is just slightly over the limit and you have high medical bills, call your Medicaid office and ask specifically about the “Medically Needy” or “Spend-Down” program.⁵
5. Map Your Local Safety Nets: Use the HRSA tool to find your nearest Community Health Center (FQHC).⁴³ Go to your local hospital’s website and download their Charity Care policy so you know the rules before you ever need it.⁷
6. Avoid Risky Shortcuts: Delete the emails and ignore the ads for short-term insurance. The risk is not worth the perceived savings.⁴⁷

This journey is not easy.

The map can be confusing, and the system can feel impersonal and cruel.

But you are not powerless.

With this map in hand, you have the knowledge to look past the dead ends, find the transfer points, and navigate your way to the security and peace of mind that comes with knowing you are covered.

You can do this.

Works cited

1. Health Coverage Policy Explorer: Glossary – Texas 2036, accessed August 11, 2025, https://texas2036.org/health-coverage-explorer/glossary/
2. Federal Poverty Level (FPL) – Glossary | HealthCare.gov, accessed August 11, 2025, https://www.healthcare.gov/glossary/federal-poverty-level-fpl/
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