Medicaid Policy
Medicaid Policy
Previous Policy (440-1 was previously found in section 232 until November 1, 2021)
A. "Modified Adjusted Gross Income”
The term "Modified Adjusted Gross Income" or MAGI, refers to a methodology of determining if an individual is eligible for medical assistance. See section 300 for the list of MAGI Based programs.
B. MAGI Methodology
1. The MAGI methodology follows federal tax rules for determining a household size, whose income counts and the amount of that income, and the eligibility group for each individual applying for medical assistance.
· There are some exceptions to the tax rules when determining household size and countable income.
2. There are some households and individuals for whom we will use non-tax filer rules to determine their household size.
· We will use the relationship rules for these non-tax-filing MAGI households.
· The relationship rules may be applied differently than they are for non-MAGI-based eligibility groups (229).
3. There is no asset test for the eligibility groups to which MAGI methodology apply.
C. Non-Financial Rules for MAGI
1. Individuals being determined eligible using the MAGI methodologies must meet the basic non-financial rules such as citizenship or non-citizen status, state residency, medical support enforcement when applicable, provision of a Social Security number, TPL, etc. (200).
2. Emergency medical assistance under a MAGI-based group is available to individuals who do not meet citizenship or non-citizen status rules, but who meet the other criteria for a MAGI-based eligibility group.
D. Steps in Using the MAGI Methodology
Each of these following steps will be described in detail in the indicated sections.
1. Determine the household size and composition for each individual applying for medical assistance (401-2).
2. Determine whose income counts for each individual (413-1).
3. Determine the modified adjusted gross income of each person whose income counts for the individual, and the total income for the applicable household (440-5).
4. Determine the appropriate eligibility group for each individual.
5. Determine the eligibility of each individual.