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Advance Premium Tax Credits Paid to Individuals Enrolled in Both Affordable Care Act Qualified Health Plans and Medicaid

Announced on  | Last Modified on  | Project Number: OAS-26-02-085
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Under the Affordable Care Act (ACA), individuals who enroll in qualified health plans (QHPs) may be eligible for premium tax credits. These credits reduce the cost of QHP premiums and may be claimed at tax-filing time or received in advance. When paid in advance, the credit is referred to as an advance premium tax credit (APTC). APTCs are paid monthly by the Federal Government directly to QHP issuers on behalf of enrollees to offset a portion or all of their premium costs. Individuals enrolled with full-scope Medicaid benefits are not eligible to receive an APTC through a QHP. We will determine whether APTCs were paid on behalf of individuals enrolled in an ACA QHP who were concurrently enrolled in Medicaid or individuals who were deceased during calendar year 2025.

TIMELINE

  • August 17, 2026
    Announced
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Departmental Operational Issues Financial Stewardship Healthcare Exchanges and Marketplaces
Target Groups
-
Financial Groups
Grants Medicaid