1Instructions: Application for Health Coverage & Help Paying Costs
Instructions to Help You Complete
the Application for Health Coverage
& Help Paying Costs
During Open Enrollment (November 1–January 15)
each year (or outside of it, if eligible), you can apply
for health coverage through the Health Insurance
Marketplace
®
. The Marketplace helps you nd health
coverage that ts your budget and meets your needs.
When you apply, you’ll nd out if you can get savings
that you can use right away to help you lower your
premium amount for a Marketplace plan. You can also
nd out if you qualify for free or low-cost coverage
through Medicaid or the Children’s Health Insurance
Program (CHIP).
There are dierent ways to apply. HealthCare.gov is
the fastest way to apply. If you apply online, you’ll also
get your Eligibility Notice right away.
These instructions include additional help for some,
but not all, of the items in the paper application.
Before you start, have this information ready:
n Social Security Numbers (SSNs)
n Dates of birth
n Document numbers for eligible immigrants who
want health coverage
n Paystubs, W-2 forms, or other information about
your household’s income
n Policy/member numbers for any current health
coverage
n Information about any health coverage from a job
that’s available to you or your household
This application has 6 steps.
Use blue or black ink to complete it.
Step 1: Tell us about yourself.
(Page 1)
An adult (18 or older) must enter their contact
information. We need this information so we can
follow up with you if we have questions about your
application and so we can let you know what plans or
programs you qualify for.
Step 2: Tell us about your
household. (Pages 1–2)
You need to provide information about everyone on
your federal income tax return and all household
members who live with you, even if they aren’t applying
for health coverage. Start with yourself.
Your household size and income help determine what
programs you qualify for. Read the information at the
bottom of page 1 (“Who do you need to include on
this application?”) carefully to gure out which people
to add in Step 2. The application has space for up to 2
people.
If you have more than 2 people in your household,
make copies of pages 5–7 and complete them for each
additional person.
2 Instructions: Application for Health Coverage & Help Paying Costs
Use this chart to help determine who you should or shouldn’t include in this section.
INCLUDE these people even if they
aren’t applying for health coverage
themselves.
DON’T INCLUDE these people if they want
to apply for health coverage. They must
ll out a separate application.
For ADULTS who
need coverage:
All people who are on the same federal
income tax return, including spouses
and dependents
Any spouse who lives with you, even if
you aren’t on the same tax return
Any children, including stepchildren,
who live with you, even if you aren’t on
the same tax return
Certain people who aren’t on your federal
income tax return, including:
Any unrelated people who live with you
Any household members who aren’t your
spouse or children, including parents or
adult siblings, even if they live with you
Any household members, like sons or
daughters, who don’t live with you
For CHILDREN who
need coverage:
All people who are on the same federal
income tax return, including parents
and siblings
Any parent, including stepparents, who
lives with you, even if you’re not on the
same tax return
Any siblings (including stepsiblings and
half siblings) who live with you, even if
you’re not on the same tax return
Certain people who aren’t on the same
federal income tax return, including:
Any unrelated people who live with you
Any household members who aren’t
parents or siblings, like grandparents,
even if they live with you
Any household members, including
parents, who live separately from you
PERSON 1: (Start with yourself)
(Pages 2–3)
Need health coverage?
Complete the whole page.
Don’t need health coverage?
Complete items 1–9.
Item 5
For anyone enrolling in health coverage, we share your
answer for “Sex” with your insurance company. If your
current sex is dierent from your sex assigned at birth,
you can select the answer based on the information you
want to share. The application also includes optional
questions if you want to share more detail on your
gender identity. If you’re pregnant, be sure to select
“Female” so that you can tell us about the pregnancy.
Item 7
You can still apply for coverage even if you don’t
plan to le a federal income tax return:
n If you’re married and interested in getting the
premium tax credit, you’ll need to le your federal
income tax return jointly with your spouse to get the
tax credit.
n If you’re claimed as a dependent on someone else’s
tax return, list the names of the tax ler(s).
n If you’re claimed as a dependent, include how you’re
related to the tax ler. For example, if you’re the
child of the tax ler, list “child.”
Item 10
If you have a special health care need or a physical
or mental health condition that limits activities
(like working, attending school, dressing, bathing,
etc.), or live in a medical facility or nursing home,
answering “yes” won’t increase your health care costs.
If you have a disability or special health care need, you
may qualify for free or low-cost coverage.
Item 13
If you aren’t a U.S. citizen but have eligible
immigration status to get coverage through the
Marketplace, ll in “yes” and add your document type
and document ID number(s). (Get details on pages 6–8
of these instructions.) If you have more than one of
these documents, list all of them.
3Instructions: Application for Health Coverage & Help Paying Costs
Items 18–22
Ethnicity, race, gender identity and sexual
orientation questions are optional, but this
information helps the U.S. Department of Health and
Human Services improve service to all people using
the Marketplace. We use this information to make sure
everyone gets fair access to coverage. We won’t share
sexual orientation and gender identity information with
your state, your insurance company, or your health
care providers, and we must protect the privacy of your
information. Your responses are only accessible to
certied third-party professionals like assisters, agents
or brokers, and certied enrollment partners. Providing
this information won’t impact eligibility, plan options,
or costs. And it can’t be used to discriminate or deny
health coverage or health care services.
PERSON 1: Current job & income
information (Pages 3–4)
We ask about your current income to nd out if you
qualify for help paying for coverage and how much
help you can get. Include how much you make in wages
and tips before taxes are deducted. You don’t have
to include amounts taken out of your check by your
employer for child care, health insurance, or retirement
plans that are “not taxable” (sometimes called “pre-tax
deductions”).
If you’re self-employed:
Fill in the type of work you do and how much net
income you’ll get this month. Net income is the amount
left over after you’ve taken out business expenses. The
amount can be positive or negative. Go to the list of
self-employment income deductions on page 8 of these
instructions to nd out what you can subtract from
your gross income.
Item 34
Deductions: List any deductions you’re able to claim on
your Schedule 1 of IRS Form 1040.
PERSON 2 (Pages 5–6)
Need health coverage?
Complete the whole page.
Don’t need health coverage?
Complete items 1–10.
Item 2
Use these relationships to describe how PERSON 2 is
related to you:
n Spouse
n Domestic partner
n Child (including
adopted child)
n Stepchild
n Child of domestic
partner (including
adopted child)
n Sibling (including half &
stepsibling)
n Parent (including
adoptive parent)
n Stepparent
n Parent’s domestic
partner
n Grandparent
n Grandchild
n Niece or nephew
n Aunt or uncle
n First cousin
n Mother-in-law or
father-in-law
n Daughter-in-law or
son-in-law
n Sister-in-law or
brother-in-law
n Other relative (by blood
or marriage)
n Unrelated (not by blood
or marriage)
Item 5
For anyone enrolling in health coverage, we share
their answer for “Sex” with their insurance company.
If PERSON 2’s current sex is dierent from their sex
assigned at birth, select the answer based on the
information PERSON 2 wants to share. The application
also includes optional questions if PERSON 2 wants to
share more detail on their gender identity. If PERSON
2 is pregnant, be sure to select “Female” so we know
about the pregnancy.
Item 8
You can still apply for coverage even if PERSON 2
doesn’t plan to le a federal income tax return:
n If PERSON 2 is married and interested in getting
premium tax credits, PERSON 2 will need to le
jointly with their spouse to get the tax credit.
n If PERSON 2 is claimed as a dependent on someone
else’s tax return, list the names of the tax ler(s).
n If PERSON 2 is claimed as a dependent, include how
they’re related to the tax ler(s).
For example, if PERSON 2 is the child of the tax ler, list
“child.”
3
4 Instructions: Application for Health Coverage & Help Paying Costs
Item 11
If PERSON 2 has a physical or mental health
condition that causes limitations in activities (like
working, attending school, dressing, or bathing), or if
PERSON 2 has a special health care need, or lives in a
medical facility or nursing home, answering “yes” won’t
increase their health care costs. If PERSON 2 has a
disability or special health care need, they may qualify
for free or low-cost coverage.
Item 14
If PERSON 2 isn’t a U.S. citizen but has eligible
immigration status, ll in “yes” and provide their
document type and document ID number(s). (Get
details on pages 6–8 of these instructions.) If PERSON 2
has more than one of these documents, list all of them.
Item 12 doesn’t need to be completed if PERSON 2 isn’t
applying for health coverage.
Items 20–24
Ethnicity, race, gender identity and sexual
orientation questions are optional, but this
information helps the U.S. Department of Health and
Human Services improve service to all people using
the Marketplace. We use this information to make sure
everyone gets fair access to coverage. We won’t share
sexual orientation and gender identity information
with PERSON 2’s state, insurance company, or health
care providers, and we must protect the privacy of
their information. Responses are only accessible
to certied third-party professionals like assisters,
agents or brokers, and certied enrollment partners.
Providing this information won’t impact PERSON 2’s
eligibility, plan options, or costs. And it can’t be used
to discriminate or deny health coverage or health care
services.
PERSON 2: Current job & income
information (Pages 6–7)
Give information about PERSON 2’s current income
to nd out if they’re eligible for help paying for health
coverage. Include how much PERSON 2 makes in wages
and tips before taxes are deducted. You don’t have to
include amounts taken out of PERSON 2’s check by their
employer for child care, health insurance, or retirement
plans that are “not taxable” (sometimes called “pre-tax
deductions”).
If PERSON 2 is self-employed:
Fill in the type of work PERSON 2 does and how much
net income they’ll get this month. Net income is the
amount left over after business expenses have been
taken out. The amount can be positive or negative. Go
to the list of self-employment income deductions on
page 8 of these instructions to nd out what can be
subtracted from PERSON 2’s gross income.
Item 36
Deductions: List any deductions PERSON 2 is able to
claim on PERSON 2’s Schedule 1 of IRS Form 1040.
Step 3: American Indian or
Alaska Native (AI/AN) household
member(s) (Page 8)
If anyone in your household is American Indian or
Alaska Native, ll in “yes,” complete Appendix B:
American Indian or Alaska Native (AI/AN) Household
Member(s), and submit it with your application.
Members of federally recognized tribes and individuals
who are eligible to get care through Indian Health
Service providers may be eligible for special protections.
Step 4: Your household’s health
coverage (Page 8)
Item 1
If your state said anyone in your household didn’t
qualify for Medicaid or the Children’s Health Insurance
Program (CHIP) in the past 90 days, list their names and
the date here.
5Instructions: Application for Health Coverage & Help Paying Costs
Item 2
If anyone in your household is oered health coverage
from a job (whether it’s their own job or another
person’s job):
n Fill in “yes” even if they’re oered coverage but aren’t
currently enrolled.
n Fill in “no” if the only coverage someone in your
household is oered is COBRA or retiree insurance.
If someone in your household is oered coverage,
complete Appendix A: Health Coverage from Jobs, and
submit it with your application. If no, skip to Step 5.
We also ask if the employer oers an individual
coverage Health Reimbursement Arrangement (HRA)
or a Qualied Small Employer HRA (QSEHRA). These
aren’t traditional job-based health plans. The employer
chooses a dollar amount they’ll reimburse for medical
expenses instead of oering a health plan.
The employer can’t oer you an individual coverage
HRA or QSEHRA and a traditional job-based plan. If
you aren’t sure if the employer oers an individual
coverage HRA or QSEHRA, ask them. If anyone on your
application is oered one of these, the Marketplace will
follow up with you for more information.
Items 3–4
If any of the people applying for health coverage are
currently enrolled in a type of health coverage listed on
page 8 of the application, check the type of coverage,
write the person’s name next to the coverage they have,
and include other information as requested.
Step 5: Your agreement &
signature (Page 9)
Read the statements on these pages, sign your name,
and write today’s date. By signing, you’re agreeing
that the information you gave is true and correct. If
you or someone applying for health insurance on this
application is incarcerated (detained or jailed), ll in
“yes” and write their name in the space given. If the
person is pending disposition of charges, ll in the
circle.
If an authorized representative helped you ll out
this application:
n They can sign the form for you, but they’ll need
to complete Appendix C: Help Completing this
Application, and submit it with your application.
n You (PERSON 1 on the application) must sign
Appendix C to allow the authorized representative
to sign this application, get ocial information about
this application, and act for you on all future matters
related to this application.
Step 6: Mail completed application
(Page 10)
Make a copy of your application to keep for your
records, then mail all original pages to:
Health Insurance Marketplace
Dept. of Health and Human Services
465 Industrial Blvd.
London, KY 40750-0001
Use the correct amount of postage when you mail
your application. It’ll depend on the weight of your
application, which will be based on the number of
pages.
If you don’t have all the information or you can’t nish
all the items, send in your application anyway. We’ll
follow up with you within 1–2 weeks.
Next steps
You’ll get an Eligibility Notice that tells you if you or
anyone in your household can enroll in health coverage
through the Marketplace. It will also include information
on how to enroll in coverage (if you’re eligible).
Get help in a language other than
English (Pages 10–11)
You have the right to get help and information in your
language at no cost to you. To talk to an interpreter, call
1-800-318-2596.
6 Instructions: Application for Health Coverage & Help Paying Costs
Eligible immigration status list
Use this list to answer questions about eligible immigration status on pages 2 and 5. If you nd your status below,
ll in the box that says “yes.”
n Lawful permanent resident (LPR/Green Card holder)
n Lawful temporary resident
n Member of a federally recognized Indian tribe or
American Indian born in Canada
n Asylee
n Refugee
n Cuban/Haitian entrant
n Paroled into the U.S.
n Conditional entrant granted before 1980
n Battered spouse, child, or parent
n Victim of tracking and their spouse, child, sibling,
or parent
n Granted Withholding of Deportation or Withholding
of Removal under the immigration laws or under the
Convention against Torture (CAT)
n Individual with non-immigrant status (including
worker visas, student visas, and citizens of
Micronesia, the Marshall Islands, and Palau)
n Temporary Protected Status (TPS)
n Deferred Enforced Departure (DED)
n Deferred Action Status (Exception: Deferred Action
for Childhood Arrivals (DACA) isn’t an eligible
immigration status for applying for health coverage.)
n Administrative order staying removal issued by the
Department of Homeland Security
n Applicant for:
Special Immigrant Juvenile Status
Adjustment to LPR Status with an approved visa
petition
Victim of tracking visa
Asylum who has either been granted employment
authorization, OR is under 14 and has had an
application for asylum pending for at least 180
days
Withholding of Deportation or Withholding of
Removal, under the immigration laws or under
the Convention against Torture (CAT) who has
either been granted employment authorization,
OR is under 14 and has had an application for
withholding of deportation or withholding of
removal under the immigration laws or under the
CAT pending for at least 180 days
n Certain individual with employment authorization
document:
Registry applicant
Order of supervision
Applicant for Cancellation of Removal or
Suspension of Deportation
Applicant for Legalization under Immigration
Reform and Control Act (IRCA)
Applicant for Temporary Protected Status (TPS)
Legalization under the LIFE Act
7Instructions: Application for Health Coverage & Help Paying Costs
Immigration status and document types
If you’re an eligible non-citizen applying for health coverage, write the name of your immigration document on
page 2 (and page 5, if any household members are applying for coverage). Go to the list below for some common
document types. If your document isn’t listed, you can still write its name. If you’re not sure, or you have an
eligible status but no document, call the Marketplace Call Center at 1-800-318-2596 for help. TTY users can call
1-855-889-4325.
IF YOU HAVE: LIST THESE FOR THE DOCUMENT ID:
Permanent Resident Card, “Green Card” (I-551) Alien number
Card number
Reentry Permit (I-327)
Alien number
Refugee Travel Document (I-571)
Alien number
Employment Authorization Card (I-766)
Alien number
Card number
Expiration date
Category code
Machine Readable Immigrant Visa (with temporary
I-551 language)
Alien number
Passport number
Country of issuance
Temporary I-551 Stamp (on passport or 1-94/1-94A)
Alien number
Arrival/Departure Record (I-94/I-94A)
I-94 number
Arrival/Departure Record in foreign passport (I-94)
I-94 number
Passport number
Expiration date
Country of issuance
Foreign passport
Passport number
Expiration date
Country of issuance
Certicate of Eligibility for Nonimmigrant Student
Status (I-20)
SEVIS ID
Certicate of Eligibility for Exchange Visitor Status
(DS2019)
SEVIS ID
Notice of Action (I-797)
Alien number or an I-94 number
Other
Alien number or an I-94 number
Description of the type or name of the document
For more eligible immigration documents or statuses, continue to the next page.
8 Instructions: Application for Health Coverage & Help Paying Costs
You can also list these documents or statuses:
n Document indicating a member of a federally
recognized Indian tribe or American Indian born
in Canada (Note: This is considered an eligible
immigration status for Medicaid, but not for a
Marketplace health plan.)
n Oce of Refugee Resettlement (ORR) eligibility
letter (if under 18)
n Certication from U.S. Department of Health
and Human Services (HHS) Oce of Refugee
Resettlement (ORR)
n Cuban/Haitian entrant
n Battered spouse, child, or parent under the
Violence Against Women Act (VAWA)
For people who are self-employed
(continued from page 3)
If you have any of these expenses, you can
subtract them from your gross income to get an
amount for your net self-employment income:
n Car and truck expenses (for travel during the
workday, not commuting)
n Employee wages and fringe benets
n Interest (including mortgage interest paid to
banks, etc.)
n Rent or lease of business property and utilities
n Advertising
n Repairs and maintenance
n Deductible self-employment taxes
n Contributions to a self-employed Simplied
Employee Pension (SEP), SIMPLE, or qualied
retirement plan
n Property, liability, or business interruption
insurance
n Depreciation
n Legal and professional services
n Commissions, taxes, licenses, and fees
n Contract labor
n Certain business travel and meals
n Cost of self-employed health insurance
9Instructions: Appendix
Appendix A: Health Coverage
from Jobs
If anyone in your household has an oer of health
coverage from a job, including through a parent or
spouse, provide information on the oer of coverage,
regardless of whether the person is currently enrolled.
Items 15-16:
Fill in the premium amount that you or anyone in your
household would have to pay for the lowest cost plan
that covers only the employee or the employee and the
household.
Complete one page for each employer that oers
health coverage. You can use our Employer Coverage
Tool (HealthCare.gov/downloads/employer-coverage-
tool.pdf) worksheet to help you gather this information.
Appendix B: American Indian or
Alaska Native (AI/AN)
If you or a household member are American Indian or
Alaska Native, complete Appendix B. You’ll be asked
about the person’s tribe membership, income, and
other information.
Appendix C: Help with Completing
this Application
n Certied application counselors, navigators,
in-person assistance counselors, and other
assisters: These professional individuals and
organizations are trained to help consumers
looking for health coverage options through the
Marketplace, including help with completing this
application. Services are free to consumers. You
can ask for certication showing they’re authorized
to perform this work. They can help you complete
this section. The ID number is the navigator’s
identication number. This is a unique ID (13 letters
and numbers) given to each navigator.
n Agents and brokers: Agents and brokers can help
you apply for help paying for coverage and enroll
in a Marketplace plan. They can make specic
recommendations about which plan you should
enroll in. They’re also licensed and regulated by
states and typically get payments or commissions
from health insurance companies when they enroll
consumers. They can help you complete this section.
List both ID numbers for agents and brokers.
• FFM User ID: A unique ID that the agent or broker
creates when registering with the Marketplace.
• National Producer Number (NPN): A unique
number (up to 10 digits) that’s assigned to each
licensed agent or broker. You can nd a licensed
agent or broker’s NPN by visiting the National
Insurance Producer Registry’s website at
nipr.com.
n You can choose an authorized representative.
This is someone you choose to act on your behalf
with the Marketplace, like a household member
or other trusted person. Some authorized
representatives may have legal authority to act on
your behalf.
Instructions to Help You Complete
an Appendix
10 Instructions: Appendix
Appendix D: Questions about life
changes
A change in your life can make you eligible for a
Special Enrollment Period to enroll in health coverage.
Examples of qualifying life events are moving to a new
state, certain changes in your income, and changes in
your household size (like if you marry, divorce, or have
a baby). For a full list of life events, visit
HealthCare.gov/coverage-outside-open-enrollment/
special-enrollment-period.
11Privacy Act Statement
Privacy Act Statement
Permission for information submitted
By submitting this application, you represent that you have permission from all of the people whose information is on the
application to both submit their information to the Marketplace, and receive any communications about their eligibility and
enrollment.
Privacy Act Statement – eective 10/1/2013
We are authorized to collect the information on this form
and any supporting documentation, including social security
numbers, under the Patient Protection and Aordable Care
Act (Public Law No. 111-148), as amended by the Health Care
and Education Reconciliation Act of 2010 (Public Law No. 111-
152), and the Social Security Act.
We need the information provided about you and the other
individuals listed on this form to determine eligibility for: (1)
enrollment in a qualied health plan through the Federal
Health Insurance Marketplace, (2) insurance aordability
programs (such as Medicaid, CHIP, advanced payment of the
premium tax credits, and cost sharing reductions), and (3)
certications of exemption from the individual responsibility
requirement. As part of that process, we will verify the
information provided on the form, communicate with you
or your authorized representative, and eventually provide
the information to the health plan you select so that they
can enroll any eligible individuals in a qualied health plan
or insurance aordability program. We will also use the
information provided as part of the ongoing operation of the
Marketplace, including activities such as verifying continued
eligibility for all programs, processing appeals, reporting
on and managing the insurance aordability programs for
eligible individuals, performing oversight and quality control
activities, combatting fraud, and responding to any concerns
about the security or condentiality of the information.
While providing the requested information (including social
security numbers) is voluntary, failing to provide it may delay
or prevent your ability to obtain health coverage through the
Marketplace, advanced payment of the premium tax credits,
cost sharing reductions, or an exemption from the shared
responsibility payment. If you don’t have an exemption from
the shared responsibility payment and you don’t maintain
qualifying health coverage for three months or longer during
the year, you may be subject to a penalty. If you don’t provide
correct information on this form or knowingly and willfully
provide false or fraudulent information, you may be subject
to a penalty and other law enforcement action.
In order to verify and process applications, determine
eligibility, and operate the Marketplace, we will need to
share selected information that we receive outside of CMS,
including to:
1. Other federal agencies, (such as the Internal Revenue
Service, Social Security Administration and Department
of Homeland Security), state agencies (such as
Medicaid or CHIP) or local government agencies. We
may use the information you provide in computer
matching programs with any of these groups to make
eligibility determinations, to verify continued eligibility
for enrollment in a qualied health plan or Federal
benet programs, or to process appeals of eligibility
determinations. Information provided by applicants won’t
be used for immigration enforcement purposes;
2. Other verication sources including consumer reporting
agencies;
3. Employers identied on applications for eligibility
determinations;
4. Applicants/enrollees, and authorized representatives of
applicants/enrollees;
5. Agents, Brokers, and issuers of Qualied Health Plans,
as applicable, who are certied by CMS who assist
applicants/enrollees;
6. CMS contractors engaged to perform a function for the
Marketplace; and
7. Anyone else as required by law or allowed under the
Privacy Act System of Records Notice associated with this
collection (CMS Health Insurance Exchanges System (HIX),
CMS System No. 09-70-0560, as amended, 78 Federal
Register, 8538, March 6, 2013, and 78 Federal Register,
32256, May 29, 2013).
Identity Verication
To protect your privacy, you will need to complete Identity
Verication successfully before requesting higher account
privileges. You are providing consent to Experian, an external
identity verication provider, to access your personal
information to conduct ID Verication on behalf of CMS.
Below are a few items to keep in mind.
Ensure that you have entered your legal name, current home
address, primary phone number, date of birth, and email
address correctly. We will collect personal information only to
verify your identity with Experian.
Identity Verication involves Experian using information from
your consumer report prole to help conrm your identity.
As a result, you may see an entry called a “soft inquiry” on
your Experian consumer report. Soft inquiries are visible only
to you, will never be presented to third parties, and do not
aect your credit score. The soft inquiry will be titled “CMS
Proong Services” and will be removed from your Experian
consumer report after 25 months.
You may need to have access to your personal and consumer
report information, as the Experian application will pose
questions to you, based on data in their les.
This statement provides the notice required by the Privacy
Act of 1974 (5 U.S.C. § 552a(e)(3)). You can learn more about
how we handle your information at:
HealthCare.gov/how-we-use-your-data.
This product was produced at U.S. taxpayer expense.
You have the right to get your information in an accessible format, like large print, braille, or audio.
You also have the right to le a complaint if you feel you’ve been discriminated against.
Visit CMS.gov/About-CMS/Agency-Information/Aboutwebsite/CMSNondiscriminationNotice
or call 1-800-318-2596. TTY users can call 1-855-889-4325.
Health Insurance Marketplace
®
is a registered service mark of
the U.S. Department of Health & Human Services.
CMS Product No. 11708
September 2023
CMS doesn’t exclude, deny benets to, or otherwise discriminate against any person on the basis of
race, color, national origin, disability, sex (including sexual orientation and gender identity), or age in admission to,
participation in, or receipt of the services and benets under any of its programs and activities, whether carried out by CMS
directly or through a contractor or any other entity with which CMS arranges to carry out its programs and activities.
