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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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    Faith Lee
    Rhode Island
    Death
    Under MAGI Medicaid, how do we redetermine the MAGI household after one member of the household is deceased? I've heard we need to passively redetermined the entire household. However, how can we passively redetermined the entire household without... read more

    Under MAGI Medicaid, how do we redetermine the MAGI household after one member of the household is deceased? I've heard we need to passively redetermined the entire household. However, how can we passively redetermined the entire household without knowing who will be the tax filer?

    replyFebruary 5th, '15
    Brian Shea
    New York
    Medicaid Application

    Can a Husband apply through the New York Health Exchange (Magi Budgeting) for coverage of his deceased wife's hospital bills?. His wife died in the hospital.

    Thanks

    replyDecember 24th, '14
    MAGI Medicaid Eligibility and Medicare Cost Sharing
    Based on CMS Final Rule from 2012, individuals eligible for Medicare can have their eligibility determined based on MAGI if they meet criteria for MAGI eligibility groups. Can a person receive both MAGI Medicaid and Medicare cost sharing provided the... read more

    Based on CMS Final Rule from 2012, individuals eligible for Medicare can have their eligibility determined based on MAGI if they meet criteria for MAGI eligibility groups. Can a person receive both MAGI Medicaid and Medicare cost sharing provided the person meets requirements for both? For example, a woman who received Medicare cost sharing is now pregnant and qualifies for MAGI Medicaid.

    replyOctober 9th, '14
    Re: MAGI Medicaid Eligibility and Medicare Cost Sharing

    Yes, a person can receive coverage under a MAGI program (like Pregnant Woman or Caretaker Relative) and Medicare Savings Program if the requirements for both programs are met.

    Re: MAGI Medicaid Eligibility and Medicare Cost Sharing

    Julie,
    Do you know if CMS has issued anything on this topic? Thank you!

    October 9th, '14
    Re: MAGI Medicaid Eligibility and Medicare Cost Sharing

    Hi Natasha,

    I have not seen any guidance on this specific question. My response is based on it being allowed before MAGI, and there does not appear to be anything in the MAGI provisions that would change this.

    October 9th, '14
    Re: MAGI Medicaid Eligibility and Medicare Cost Sharing

    Thank you, Julie! I have the same understanding, just wanted to make sure I was not missing anything.

    October 9th, '14
    Faith Lee
    Rhode Island
    death

    How do MAGI MEDICAID determine eligibility after a member of the family or Head of Household is deceased?

    replySeptember 24th, '14
    Wayne Turner
    District of Columbia
    Re: death
    Significant life changes, such as the death of a dependent or other member of the MAGI household, must be reported to the Marketplace or Medicaid agency because it affects household size.... read more

    Significant life changes, such as the death of a dependent or other member of the MAGI household, must be reported to the Marketplace or Medicaid agency because it affects household size.

    In the Marketplace, the amount of a Premium Tax Credit is recalculated based upon the new household size. If the death resulted in the loss of Minimum Essential Coverage for surviving household members, then that could trigger a Special Enrollment Period to purchase or switch plans through the Marketplace.

    In Medicaid, the loss of a MAGI household member would trigger a redetermination of eligibility based upon the reduced household size (and income, if applicable). However, before a state Medicaid agency terminates coverage for someone found ineligible under MAGI, the agency must see if that individual might be eligible under another category (e.g., pregnant women, disability, etc.)

    Age limit for children?
    42 CFR 435.603 states the criteria for disregarding the income of "children." Is there an age limit for this disregard under filer rules? If so, does it follow the age criteria for being a "qualified child" or is it the same as a state's definition... read more

    42 CFR 435.603 states the criteria for disregarding the income of "children." Is there an age limit for this disregard under filer rules? If so, does it follow the age criteria for being a "qualified child" or is it the same as a state's definition for children under non-filer rules or something else entirely? I have copied the CFR below.
    (2) Income of children and tax dependents. (i) The MAGI-based income of an individual who is included in the household of his or her natural, adopted or step parent and is not expected to be required to file a tax return under section 6012(a)(1) of the Code for the taxable year in which eligibility for Medicaid is being determined, is not included in household income whether or not the individual files a tax return.

    replyAugust 6th, '14
    Re: Age limit for children?
    Since, under 603(f), children are included in a parent's household if claimed as a tax dependent, which is covered by (d)(2)(ii), or under the age specified in (f)(3)(iv). My interpretation is that the definition of child under the non-filer rules... read more

    Since, under 603(f), children are included in a parent's household if claimed as a tax dependent, which is covered by (d)(2)(ii), or under the age specified in (f)(3)(iv). My interpretation is that the definition of child under the non-filer rules applies.

    August 6th, '14
    Budget Period for Retroactive Month
    For retroactive MAGI-based Medicaid coverage, should income be calculated based on the calendar month it was received in or is it acceptable for a state to average income received from more than one calendar month? The state manual references 42 CFR... read more

    For retroactive MAGI-based Medicaid coverage, should income be calculated based on the calendar month it was received in or is it acceptable for a state to average income received from more than one calendar month? The state manual references 42 CFR 435.603 as copied below.
    (h) Budget period—(1) Applicants and new enrollees. Financial eligibility for Medicaid for applicants, and other individuals not receiving Medicaid benefits at the point at which eligibility for Medicaid is being determined, must be based on current monthly household income and family size.

    replyAugust 6th, '14
    Faith Lee
    Rhode Island
    Group VIII

    Who are the individuals considered within the group VIII?

    Thanks

    replyJuly 26th, '14
    Wayne Turner
    District of Columbia
    Re: Group VIII
    The term "Group VIII" refers to the new Medicaid eligibility group for adults created under the Affordable Care Act - adults who are under 65 who are not pregnant and not eligible under another Medicaid ... read more

    The term "Group VIII" refers to the new Medicaid eligibility group for adults created under the Affordable Care Act - adults who are under 65 who are not pregnant and not eligible under another Medicaid

    The reference is to the section in the federal statute where it appears - 42 U.S.C. 1396a(a)(10)(A)(i)(VIII)

    Faith Lee
    Rhode Island
    MAGI MEDICAID
    Q1. How does MAGI MEDICAID account for a family living together in the same household that consists of two parents who are not married and file taxes separately and one parent claims the child(ren) on their taxes? ... read more

    Q1. How does MAGI MEDICAID account for a family living together in the same household that consists of two parents who are not married and file taxes separately and one parent claims the child(ren) on their taxes?

    Q2. How does MAGI MEDICAID account for a divorce situation where the child(ren) live with the custodial parent, but the non-custodial parent claims the child(ren) on their taxes and by court order must provide the health insurance coverage. Custodial parent may be Medicaid eligible.

    Thank you in advance

    replyJune 25th, '14
    Wayne Turner
    District of Columbia
    Re: MAGI MEDICAID
    Medicaid MAGI has special rules for children who are claimed by one parent.... read more

    Medicaid MAGI has special rules for children who are claimed by one parent.

    The situation in Q1 is covered by 42 CFR 603(f)(2)(ii). For a child who is claimed by only one parent, but who lives with both parents, the Medicaid MAGI household consists of the child, the parents she lives with, and her siblings under age 18 (or 21 for full time students at state option).

    The situation in Q2 is covered by 42 CFR 603(f)(2)(iii). For a child who is claimed as a dependent by a non-custodial parent, the child's Medicaid MAGI household consists of the child, the parent she lives with, and her siblings under age 18 (or 21 for full time students at state option).

    I'm posting a link to a recording of NHeLP's MAGI training webinar that may be useful.

    Faith Lee
    Rhode Island
    Magi Medicaid Household
    If wife is pregnant (state counts as 2 people), husband (file jointly) and wife's daughter (age 7) from former relationship living with them How many people is in this MAGI medicaid household if the husband is the tax filer? Thanks in advance read more

    If wife is pregnant (state counts as 2 people), husband (file jointly) and wife's daughter (age 7) from former relationship living with them
    How many people is in this MAGI medicaid household if the husband is the tax filer?
    Thanks in advance

    replyJune 19th, '14
    Wayne Turner
    District of Columbia
    Re: Magi Medicaid Household
    Thanks for your question. ... read more

    Thanks for your question.

    The Medicaid MAGI household for the wife, the husband, and the daughter would be four - wife, unborn child(ren), husband, daughter. There are two Medicaid rules for determining in the household depending on how they file their federal income taxes. In this case they both yield the same result.

    If the wife and her husband file jointly and claim the daughter as a dependent, they will be in same Medicaid MAGI household together.

    If the child's biological father lives separately from them (e.g., non-custodial) and claims the child as a tax dependent, the child's Medicaid household consists of the child plus the parent(s) she lives with. Here, she lives with the wife/mother, and the husband, who is considered her stepfather (see 42 CFR 603(b)), and would thus be in her household.

    Note, however, that a pregnant woman might not always be counted as two people under the Medicaid rules. A pregnant woman is counted as one plus the number children expect to deliver if she is the one seeking an eligibility determination. States have flexibility to decide how to count a pregnant woman if she is in the household of someone else seeking an eligibility determination. I checked Rhode Island's State Plan Amendment implementing MAGI, and the state counts pregnant women as one plus the number of children expected to deliver in these circumstances too (if the daughter or the husband were seeking an eligibility determination).

    I hope this clarifies things - I think the key here is the fact that the stepfather is counted in the child's Medicaid household if he claims her as a dependent or if he lives with her.

    Re: Magi Medicaid Household
    Medicaid rules are very different from Exchange Premium credit rules. Medicaid rules include unborn children in the household size, and may also take into account the income of certain household members that file their own tax return. ... read more

    Medicaid rules are very different from Exchange Premium credit rules. Medicaid rules include unborn children in the household size, and may also take into account the income of certain household members that file their own tax return.

    Medicaid also (at least initially) works on monthly income, while Exchange tax credits are based on estimated annual income.

    For exchange premium credit purposes, the size of household is the number of people listed on your year end tax return including dependents you can claim. So if baby is born by end of the year it will count, and you would be regarded as a 4 person household (assuming no one else is claiming your wife's daughter as a dependent).

    Hope this helps.

    Shoshanna Goldin
    District of Columbia
    Supreme Court Ruling Extends Medicaid Eligibility for Same-Sex Marriages to Non-MAGI populations
    The recent Supreme Court decision on United States v. Windsor struck down Defense of Marriage Act (DOMA), which prohibited federal recognition of same-sex marriages in Medicaid and CHIP. States may now choose which law governs the same-sex marriage... read more

    The recent Supreme Court decision on United States v. Windsor struck down Defense of Marriage Act (DOMA), which prohibited federal recognition of same-sex marriages in Medicaid and CHIP. States may now choose which law governs the same-sex marriage rules that apply to Medicaid eligibility determinations for non-MAGI populations, according to a recently released State Health Official letter from Center for Medicare and Medicaid Services (CMS). The 2013 letter extends guidance issued on behalf of MAGI populations. The 2014 letter provides guidelines for non-MAGI populations including the elderly and people with disabilities whose eligibility for Medicaid is not determined on the basis of MAGI methodologies. In light of the operational challenges states may face in administering this change, CMS is requiring that states implement as "soon as reasonably possible."

    replyJune 5th, '14

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