Modified Adjusted Gross Income (MAGI)
The ACA requires Medicaid, CHIP and tax-subsidized exchange coverage to use Modified Adjusted Gross Income (MAGI) to determine eligibility for most individuals.
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Missouri
Is there one place to go to obtain the MAGI conversion results, by State, by program (i.e. parents and caretakers, pregnant women, children)? If not, does anyone have other good state resources for identifying this information?
Missouri
Dr. Ian McCaslin is leaving his position as Medicaid Director in Missouri. This is a huge loss for the state loss, as Dr. McCaslin is one of the best public servants I have ever met, and he has done an amazing amount of great things for the state, and is passionate about the underserved, the uninsured, children, disabled, and elderly. He will be missed a lot. Here is a story on this transition:
http://www.columbiatribune.com/news/missouri-s-medicaid-program-replaces...
Missouri
Do I understand correctly that the 5% across the board disregard does not apply to APTC eligibility?
District of Columbia
Yes, you are correct. The 5% disregard comes from 42 CFR 435.603(d). As you know, that is the Medicaid regulation on income counting. There is no corresponding disregard in 26 USC 36B, which is the statute on PTC calculation.
Michigan
I want to be sure that Shanna Hanson's post is clearly understood. The rules at 435.831 allow states to use the MAGI methodology to count income for purposes of determining spend-down (or Medicaid with a deductible) eligibility. But nothing in the ACA changes the income thresholds for spend-down eligibility. States that choose this option will need to create MAGI equivalent conversions of their current spend-down thresholds (protected income levels) if they choose to do this. Also anyone eligible under spend-down will only qualify for regular FMAP.
Virginia
I've heard CMS say they are requiring something called a "MAGI spend-down". Can someone shed light on what this is/where I can read more about it??
Kansas
I know it is in the NPRM from January 2013. But, as I understand it, it is an option.
District of Columbia
It is a state option. The theory is that certain Spend-Down eligible groups, like parents and children, will have had their Medicaid eligibility determined using MAGI methods. Therefore, for consistency sake and to minimize confusion, some states would like to use MAGI methods to also calculate the spend-down amount.
Virginia
hank you both--so helpful. Is this option described in the latest eligibility NPRM? I can't seem to find the reference, and I'd like to read more about it so I understand--I'm more familiar with Exchange eligiblity than Medicaid!
Maryland
Hi Rebecca - as I understand it, Medicaid spend down is an option States can use to allow folks who make a little too much for Medicaid to still qualify. It works something like this:
A person makes $25 more than the Medicaid MAGI eligibility limit. That person also spends $100 a month (or more) on medical expenses. The first $25 of the medical bills the person pays, while the rest would be covered by Medicaid. A person essentially, 'spends down' their income on medical expenses to a point where they qualify for Medicaid. Someone once described it to me as a like a deductible.
Hope that explanation helps, and please, if that is incorrect others jump in. I'm no Medicaid eligibility expert.
Virginia
Thanks, Ken. I think I've got a grasp on what Medicaid spend-down is... It's this term MAGI spend down that's tripping me up. So I'm looking at proposed 42 CFR 435.831 on determination of countable income for the medically needy. This is the only area I can find in the Jan NPRM that might address this option to use MAGI for calculating the spend-down to Medicaid. Does that sound right?
Maryland
Ahh - thanks for the clarification on the question and I see where you are headed. The section you reference certainly seems on-point. I looked at a few other sections that I thought could be relevant, and don't see anything that jumps out at me, but I'm not familiar enough with the regs to have an opinion.
Maybe this is a question that should be submitted to CMS?
Missouri
I don't recall where I picked this up from, but my interpretation is that, in expansion states, a person could choose to spend down to MAGI or enroll in APTC's.
• In States that continue to cover existing medically needy adult groups, adults who meet the categorical eligibility and resource requirements will have the ability to spend down to the medically needy income standard and receive the benefits covered for medically needy individuals in the State, or to enroll in the adult group (provided they meet the eligibility requirements for that group, including being under 65 and not eligible for Medicare).
• However, by expanding coverage to adults under age 65, the Affordable Care Act also provides States with the option to cover as medically needy those adults under age 65 who have incomes above the Medicaid income levels but otherwise meet the eligibility requirements of the adult group or the optional group for individuals with income over 133% of the FPL, provided that they meet spend-down requirements.
• Individuals otherwise eligible for APTCs through the Marketplace who can spend down to medically needy eligibility under Medicaid could potentially enroll in either program, depending on whether they elect to spend down to Medicaid eligibility as medically needy. Individuals who do not spend down to Medicaid eligibility may be eligible to receive APTCs for enrollment through the Marketplace.
New Jersey
I am aware that under the Medicaid Expansion rules 5% of income is excluded (changing the nominal 133% eligibility level to an effective 138% level). My question is about states which do not expand, and also about the enhanced FMAP.
Suppose that based on the MAGI conversion formula, 72% of FPL is deemed to be the equivalent to the old eligibility level plus exclusions. Is the new level under MAGI (pre-expansion) 72% or 77%? For example, suppose someone is at 75% of FPL, is this person eligible for coverage in a state which does not expand? And in a state which does expand, is this person eligible for 100% FMAP?
The 5% income disregard applies to all MAGI determinations whether the state expands or not, so the new eligibility level in your example would be 77%. However, according to the proposed rule on Medicaid, Exchanges and CHIP released in January, the 5% disregard will only be applied when determining the eligibility for a medical assistance program, not when determining a category of eligibility within a medical assistance program. In your example in a state that expands, the line for eligibility for the enhanced FMAP would be 72% and the state could receive the 100% match for a person at 75%.
District of Columbia
The SHADAC State Resources for Converting Medicaid Eligibility to MAGI page at http://www.shadac.org/content/state-resources-converting-medicaid-eligib... includes links to the December 28, 2012 Guidance, ASPE Research Briefs, CMS FAQs, and Webinar Slides.
District of Columbia
Two new ASPE Issue Briefs discuss the Standardized Modified Adjusted Gross Income (MAGI) Conversion Methodology:
http://aspe.hhs.gov/health/reports/2013/sipp/ib.cfm (SIPP data)
http://aspe.hhs.gov/health/reports/2013/MAGIHowTo/rb.cfm (state data).
District of Columbia
In a December 28, 2012 State Health Officials letter, CMS provided new guidance to assist states as they begin to plan converting current net income eligibility thresholds to equivalent modified adjusted gross income (MAGI) thresholds in the Medicaid program and Children's Health Insurance Program (CHIP). The guidance outlines the conversion methodology and process, and the timeframes for executing the conversions.
Missouri
Very helpful CMS Letter. I am looking to clarify that all States have to convert to MAGI, regardless of expansion. Is this correct? Thanks!
District of Columbia
Hi Shanna: Yes that is correct- all states will have to convert existing income counting methodologies for eligibility of nonelderly, nondisabled populations to new modified adjusted gross income (MAGI)-based levels using a CMS-approved formula that accounts for prior eligibility levels and income disregards, credits, and exclusions. The State Health Reform Assistance Network will be releasing a paper called "States’ Medicaid ACA Checklist & Resource List,” in the next few weeks on www.statenetwork.org. State Refor(u)m also just hosted a webinar about Medicaid changes in the ACA: http://www.statereforum.org/Beyond-Expansion-Decision.
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