APTC/CSR/QHP Eligibility

Beginning January 1, 2014, individuals who meet the following requirements may qualify for APTC, CSR, and QHP:

No other health coverage - The client cannot have any other health coverage available.
- Applicants who are eligible for public assistance [i.e. zero Share of Cost (SOC) MC] are ineligible for APTC.
  - Note: Applicants cannot refuse zero SOC MC, if they are eligible, in order to enroll into APTC. If applicants refuse MC but still want health coverage, they will have to pay the full-unsubsidized cost for a QHP.
- Similarly, if a client has employer-offered coverage available where the insurance premium is less than 9.5% of the total tax household annual income and provides up to 60% minimum value, the client is ineligible for APTC.
Residency - The client must be a California resident (or intend to reside in California).
Citizenship/Immigration - The client must be a United States citizen/national or lawfully present in the U.S.
Household composition - Tax filers and the dependents he/she claims are eligible for APTC.
Income - Based on percentage of Federal Poverty Level (FPL) countable and excluded income is the same for APTC/CSR as for MAGI MC.
Not incarcerated
Filing of taxes - Clients must file taxes with the IRS using a tax filing status of Single, Head of Household, or Married Filing Jointly. Applicants filing Married Filing Separately or who do not file taxes are ineligible for APTC (with few exceptions).

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