I took money out of my 401K for expenses and this has put me over the maximum income for my healthcare stipend, which means I have to pay it all back. Can I replace that money by April 15 and have it be 0?
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The deadline to roll over or reverse a 401(k) distribution is 60 days, not April 15. It's probably too late to reverse the distribution.
You might be able to contribute to a traditional IRA (if you are eligible) but I don't know if that lowers your income for purposes of the ACA subsidy. @dmertz ??
Yes, the deadline to roll over any distribution from a 401(k) received in 2019 has passed.
If a traditional IRA contribution will be deductible, yes, it will reduce modified AGI for ACA purposes.
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