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    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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    Wayne Turner
    District of Columbia
    New IRS guidance on domestic violence and tax filing status
    The IRS just released new guidance allowing married individuals in a domestic violence situation to file separate federal income taxes, but still be eligible for Premium Tax Credits. As you may recall, married couples must file jointly to be eligible... read more

    The IRS just released new guidance allowing married individuals in a domestic violence situation to file separate federal income taxes, but still be eligible for Premium Tax Credits. As you may recall, married couples must file jointly to be eligible for insurance subsidies, except in narrow circumstances where a spouse can file as "head of household."

    replyMarch 27th, '14
    Adult program as secondary coverage

    Can the Group VIII adult expansion coverage be secondary to a commercial payer? Other than Medicare, I don't recall seeing anything that would prohibit this. Thank you for your assistance.

    replyFebruary 10th, '14
    Kansas CHIP Retroactive Question
    Hello,... read more

    Hello,
    I was under the impression that part of MAGI is that all states must cover children up to the age of 19 at 133% FPL for full Medicaid. The Kansas guidelines (attached) have Children ages 6-18 at 113% for FULL Medicaid. Children may be eligible under CHIP up to 250% FPL. However, my concern is that the CHIP program does not go retroactive. Thus, if a child is in the hospital in January, but an application is not submitted until February and they are at 125%+ FPL, then they will get CHIP, but their January hospital visit would not be covered since CHIP doesn't go retroactive. Is that appropriate? Thank you!

    Molly

    replyFebruary 10th, '14
    Counting Unborn Children
    Hello,... read more

    Hello,
    I understand that states can choose how to count unborn children in the household for anyone living with a pregnant woman. Does this mean that they can choose to NOT count the unborn for those household people or are they required to at least count 1 expected baby? Also, when determining eligibility for the mother and comparing her income to the limits, is she always at least a household of 2? There is a NV DHHS rep telling us that unborn children are not counted at all for anyone....ever. Is that a possibility? Thanks for any input you can provide!

    replyFebruary 7th, '14
    Wayne Turner
    District of Columbia
    Re: Counting Unborn Children
    When a pregnant woman seeks a Medicaid eligibility determination, she is counted as one person plus the number of babies expected. (42 CFR 425.603(b)). However, under the new MAGI rules, if a pregnant woman is in the household of someone else who is... read more

    When a pregnant woman seeks a Medicaid eligibility determination, she is counted as one person plus the number of babies expected. (42 CFR 425.603(b)). However, under the new MAGI rules, if a pregnant woman is in the household of someone else who is seeking a Medicaid or CHIP eligibility determination, states can opt to count her as one person, two people, or one person plus the number of babies she is expected to deliver. (42 CFR 425.603(b)).

    All states must implement these new rules as of Jan. 1, 2014. Note, however, that they apply to Medicaid and CHIP eligibility determinations. In the Marketplace, the birth of a child is reported as a change in circumstance.

    Child Support Enforcement & MAGI

    Hello,
    Under MAGI will states still require absent parents to cooperate with child support enforcement? Thanks for the clarification!

    replyJanuary 10th, '14
    Wayne Turner
    District of Columbia
    Re: Child Support Enforcement & MAGI

    The MAGI rules do not affect child support enforcement. Here is a link to a recent report from the Congressional Research Service on medical child support that provides a good overview of current policy.

    Adult Group eligibility while pending state disability decision

    I am looking for the reference that speaks to the ability for an individual to receive Medicaid under the Adult Group in an expansion state while a state or Social Security disability decision is pending. Any assistance is appreciated. Thanks!

    replyJanuary 8th, '14
    Wayne Turner
    District of Columbia
    Re: Adult Group eligibility while pending state disability decision
    States that accept federal funds to implement the new adult expansion group must provide Medicaid to "all individuals" who meet the eligibility requirements - 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII).... read more

    States that accept federal funds to implement the new adult expansion group must provide Medicaid to "all individuals" who meet the eligibility requirements - 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII).

    Individuals are no longer eligible for the adult group once they are eligible for Medicare, are over 65, or if they become eligible for Medicaid on the basis of disability. Here is the language of the statute:

    "beginning January 1, 2014, who are under 65 years of age, not pregnant, not entitled to, or enrolled for, benefits under part A of title XVIII, or enrolled for benefits under part B of title XVIII, and are not described in a previous subclause of this clause, and whose income (as determined under subsection (e)(14)) does not exceed 133 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved, subject to subsection (k)"

    Estranged couples filing jointly
    Hello, example situation #8 of the NHelp Advocate's Guide is in regards to estranged couples filing jointly. If I understand correctly, as long as a couple is still legally married and filing a joint tax return, then they must be counted in the Medicaid... read more

    Hello, example situation #8 of the NHelp Advocate's Guide is in regards to estranged couples filing jointly. If I understand correctly, as long as a couple is still legally married and filing a joint tax return, then they must be counted in the Medicaid household regardless of where they live. Is that correct? For example, if we take the kids out of the equation and the husband wants to file for the childless adults program, he'd still have to count his wife in the Medicaid household even if they were not living together because they plan on filing a joint tax return. I see flowcharts out there that reference counting "the spouse if living with the taxpayer", but shouldn't it really be "the spouse if living with OR FILING TAXES JOINTLY with the taxpayer"? Thank you for any clarification that you can provide!

    replyDecember 31st, '13
    Re: Estranged couples filing jointly
    Married persons filing jointly must combine their household income for MAGI purposes and this is the only number used to establish Medicaid eligibility for adults and/or children. If the couple has not lived together at any time in 2013, they may file... read more

    Married persons filing jointly must combine their household income for MAGI purposes and this is the only number used to establish Medicaid eligibility for adults and/or children. If the couple has not lived together at any time in 2013, they may file as Single or Head of Household as the case may be and apply for health insurance or Medicaid separately based on individual circumstances.

    December 31st, '13
    Medicaid Household Question
    Hello All,... read more

    Hello All,
    I'm studying the NHeLP MAGI Guide and I'm confused about Household Scenario #4 - Divorced couple with children. Although this is all based on tax dependency, we do have to look at who is living together, right? So this example says that Bob's Medicaid household is 1 (just him) even though he claims one of the kids on his taxes. However, since the child doesn't spend most nights with him, is that why he's not included? I notice the worksheet wants to know who lives in the household at least 1/2 the year. Is this the big criteria on whether or not a child can be counted for a parent's eligibility? Thank you for any clarification or insight you can give me.

    replyNovember 27th, '13
    Wayne Turner
    District of Columbia
    Re: Medicaid Household Question
    Molly... read more

    Molly

    Thanks for your question. The general rule requires that the child live with the parent more than one half of the year in order to be claimed as a dependent (qualifying child). However, the IRS Code also has a special rule for divorced parents that allows them to allow a non-custodial parent to claim the child as a dependent if certain conditions are met, including the agreement of the custodial parent. The citation is 26 IRC 1529e)(1)-(3). We provide a link in the MAGI Guide to the relevant IRS publication 501 - which is also linked below.

    Thank you for highlighting this issue. We will be updating the MAGI Guide later this week and will clarify the point for folks.

    December 2nd, '13
    Re: Medicaid Household Question
    Thank you, Wayne. The guide has been immensely helpful to me and I understand what you are saying about the qualifying child for tax purposes. I am just confused on Dad's Medicaid household size because he can claim the boy on taxes, but not in the... read more

    Thank you, Wayne. The guide has been immensely helpful to me and I understand what you are saying about the qualifying child for tax purposes. I am just confused on Dad's Medicaid household size because he can claim the boy on taxes, but not in the Medicaid household, correct? If so, then the only clarification that I would suggest be added to the guide is that, for Medicaid households, tax dependency AND living arrangements (over half the year) are considered. Shucks, this could already be clear to other people. I've just been reading about it so much that my brain gets jumbled. Thank you for all of the work that you've put in to helping us understand this better!

    Re: Medicaid Household Question
    "The general rule requires that the child live with the parent more than one half of the year in order to be claimed as a dependent (qualifying child)" Actually, the rule is whichever parent is providing 51% of the child's annual support may claim the... read more

    "The general rule requires that the child live with the parent more than one half of the year in order to be claimed as a dependent (qualifying child)" Actually, the rule is whichever parent is providing 51% of the child's annual support may claim the child as a dependent. Living with one parent more than 50% of the time does not necessarily confer that status in some households.

    December 17th, '13
    Minor children's income
    Hello,... read more

    Hello,
    I know that minor children must file their own tax return if they make over a certain amount in their own wages. However, I cannot find anything official that says whether or not that income is counted for a Medicaid household. Is it added to the parent's income and counted as household income for everyone, is it counted only for the child who made the money, or is it up to the states to decide if it is counted for Medicaid or not? The NHelp guide says it May or May Not be counted. Any ideas? Thanks!

    replyNovember 11th, '13
    Wayne Turner
    District of Columbia
    Re: Minor children's income
    Thanks for you question.... read more

    Thanks for you question.

    If a child who is claimed as a tax dependent has annual income over a certain amount, then that child is required to file a tax return. The child's MAGI income will be counted towards the total household income - including the child's parents and siblings.

    The IRS establishes filing amounts every January. In tax year 2012, the amounts were as follows:

    • Unearned income, more than $950
    • Earned income, more than $5950
    • Gross income, the larger of $950 or earned income (up to $5950) plus $300

    The new MAGI rules supersede the rules in some states that prevent deeming income (for example, among step-siblings) in MAGI-applicable categories.

    Hope this helps.

    Alex Alonso
    District of Columbia
    Re: Minor children's income

    The citation is 26 U.S.C. 36B(d)(2)(A)(ii). It holds both for APTC and Medicaid. The Medicaid regulation that incorporates section 36B is 42 CFR 435.603(e). Note the language at 435.603(d)(2) though.

    M Swain
    Oregon
    MAGI coverage in Oregon
    I am a 63 year old Stage IV cancer patient, with asbestosis and thyroid and heart problems who is tube fed and subsist on $909 a month in SS income.... read more

    I am a 63 year old Stage IV cancer patient, with asbestosis and thyroid and heart problems who is tube fed and subsist on $909 a month in SS income.
    I have just learned I have been disqualified from my current OHP/Care Oregon plan because I switched over from SSI to SS to capture about $250 in additional monthly income above what SSI was paying me prior to age 62, not knowing this would cause cancellation of my OHP/Care Oregon coverage due to "Too Much Income"...(LOL)
    I have been told I will be eligible for MAGI coverage (?) effective 12-1-13?
    Is this information correct and how do I go about signing up for coverage?
    I've tried to obtain this information from my caseworker in Oregon, but she has not been helpful or forthcoming in providing me information to learn what to do and how to do it.
    My current medical expenses for doctors, medication, tube feeding supplies and nutrition exceed $4000 a month, and I will literally perish without some sort of assistance
    Any information or insight you can provide me would be deeply appreciated.
    MAS/Damascus OR

    replyOctober 30th, '13

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