Made $19k last year cleaning houses. Medicaid says no, Marketplace says my subsidy is zero.

I have two letters on the kitchen table that cannot both be right and apparently both are.

Medicaid says I am not eligible. No reason on it that I can follow, just a code and a sentence. Then I go on the Marketplace, put in the same numbers I put on the Medicaid application, and it tells me I can buy a plan at full price and my savings amount is zero dollars. Zero. Not small, not a little help, zero.

I cleaned houses last year with my sister, we do it ourselves, no company behind us. It came to about nineteen thousand dollars across the whole year and that is before gas and supplies. My husband is on disability paperwork that has been pending since March so he brings in nothing right now. Our kids are grown and out.

What I cannot make sense of is that every single article I read says if you have a low income you get help. I have a low income. That is not in dispute. So either I filled something out wrong twice or there is a rule nobody has said out loud to me. Which is it?

Neither. You are in the gap. It has a name and everything, which somehow makes it worse.

I want to say the thing I got wrong for two years, because you might be about to get it wrong too.

When my denial came I assumed it meant I earned too much. That is what a denial means everywhere else in life. So my plan was to work fewer hours, which I actually did for a while, and it made no difference at all except that I had less money. It was months before somebody at a clinic front desk said it to me the other way round, that I had earned too little to reach the bottom of the subsidy, and that there was no adult program sitting underneath to catch me.

Nobody had said it in that order before. Every letter I got said what I did not qualify for and none of them said why, and the why is the only part that would have stopped me doing something pointless.

Both letters are probably correct, and they are describing the same hole from two different sides. That is the answer, and I want it in the first line because people spend months assuming they made a clerical error.

Here is the mechanism, and none of it is about you.

Premium tax credits on the Marketplace run from 100 percent to 400 percent of the federal poverty level. Below 100 percent, HealthCare.gov's own wording is that you probably will not qualify for savings on a Marketplace plan but you may qualify for Medicaid. In most states that sentence resolves. In Texas it does not, because Texas is one of ten states that has not adopted the Medicaid expansion, so for most adults there is nothing underneath to fall into.

What Texas Medicaid does have for adults is narrow enough to state in two lines. Parents and caretaker relatives qualify up to about 15 percent of the federal poverty level, which KFF recorded as of January 2026 and which is the lowest parent threshold in the country. Take that as an indication of scale rather than a line you can measure yourself against, because Texas actually sets a dollar standard by household size and the percentage drifts every January whether or not the state changes anything. The second line is the one that catches more people here: a non disabled, non pregnant adult with no dependent children has no Medicaid category in Texas at any income at all. There is no threshold you failed to fall under, because there is no pathway.

So the two things that actually move your answer are household size and which year's income is being counted, and neither of them is effort. On the 2026 poverty guidelines a household of one is $15,960 a year, a household of two is $21,640, and a household of three is $27,320. Nineteen thousand dollars sits above 100 percent for one of those and below it for another. That single fact decides whether a subsidy exists for you, and it is why two neighbors with the same income get opposite answers. The other half is the year. The Marketplace asks you to project your income for the coverage year rather than report last year's, and Medicaid and CHIP are measured against the current year's guidelines while Marketplace eligibility for a plan year uses the prior year's. Those are different questions and people answer them with the same number.

One more thing that changed recently and catches people who last looked in 2024. The enhanced premium tax credits expired at the end of 2025, so the 400 percent cliff is back for the 2026 plan year and net premiums went up substantially for most subsidized enrollees. If somebody tells you what they paid two years ago, that number is gone.

One thing that is not on that list is running the same application again. Pregnancy, a dependent child, a disability determination, income reaching at least 100 percent, a change in who is in the household: those change the answer. An identical form submitted a second time does not, and people lose months to it.

For scale, because it helps to know it is structural: KFF estimates about 605,000 poor uninsured adults in the Texas coverage gap, roughly half the national total of about 1.2 million across all ten non expansion states. The Texas coverage gap sets out the mechanism, and what counts as income covers household composition and self employment, which is the part that bites when you and your sister are the whole business.

What I am not going to do is tell you which side of 100 percent you land on, because I am not able to determine that and neither is anybody else on this board. The Marketplace decides the subsidy and HHSC decides the Medicaid case. What I would do is sit with somebody free who reads these rules for a living. A certified application counselor or a navigator costs nothing, is not paid by an insurance company, and can go through the household and the income line by line with the application open. 2-1-1 can point you at one, and the Marketplace call center is 1-800-318-2596.

The household size thing is not theoretical, it got me. I had been counting the people living in my house. That is not the same list as the people on the tax return, and when somebody actually walked through it with me the number changed and so did the answer.

Also worth saying out loud: a pending disability claim is not the same as being determined disabled, and I wasted a whole application assuming it was.

Coming back with what happened, because I hate threads that stop.

I went to a counselor at a clinic in town, free, took about fifty minutes. Two things came out of it. My household is two, not three, because of how we file, and the income I had put on the Marketplace was last year's rather than what this year actually looks like now that my sister has taken a part time job elsewhere and we have fewer houses on the books.

I am not going to post what the outcome was because it is mine and because it will be different for whoever reads this. What I will say is that nothing about my situation changed between the two letters and the conversation. The letters were not wrong. I was answering a question I thought I understood.

The other thing she told me, which nobody had, is that Medicaid and CHIP can be applied for any time of year, and it is only the Marketplace that has a window. I had been treating January as my one shot at everything.