Obsolete 0715 - 347 MAGI Based Medicaid for Children

Effective Date: January 1, 2014 - June 30, 2015

No Previous MAGI Policy

Contact DWS Program Specialist for Child Medicaid (350) prior to MAGI

A. Child Age 0-1 Born to a Mother on Medicaid

1. A child born to a mother who was eligible for and received Medicaid on the date of the child’s birth can receive coverage through the month the child turns one year old. This applies to:

o any Utah Medicaid program, except the PCN program, which does not require a spenddown or premium or,

o A Utah Medicaid program by meeting a spenddown or an MWI premium in the month that the child was born.

2. Changes in household circumstances during the first year do not affect eligibility for the child unless the child is no longer a state resident or the family requests the case be closed.

3. The child does not have to continue to live with the birth mother. If the child changes households, the new household must re-apply on behalf of the child to continue the coverage for the remainder of the year. In the case of an adoption, the birth mother's Medicaid eligibility in the birth month should be verified without divulging her personal information.

B. Child Under 19

1. The child must meet citizenship and state residency requirements.

2. There is no asset test to determine eligibility.

3. Countable household income must be under the MAGI income standard. There are different income limits for a child 0-5 and a child 6-18. See Table VII.

4. When a child turns 6, determine if the income is under the limit for Child 6-18 and continue coverage if eligible. Otherwise, determine if the child is eligible for CHIP.

C. Eligibility for Other Programs

1. If a child is over the income limit for the Child Under 19 program, consider the Child Medically Needy program (see section 353), or CHIP (See CHIP policy section 700).

2. In 2014, children who were eligible for Medicaid in December 2013 and who are no longer eligible for Medicaid, are eligible for CHIP for one year if the MAGI-based income for the child's HH is under 200% FPL. Open the child on CHIP even if the child has health insurance that would normally prevent CHIP enrollment.

a. It does not matter if they have other health insurance. However, the following children would remain ineligible for CHIP.

o Children who have access to coverage through a public employee health insurance plan.

o Children who are inmates of a public institution.

o Children who are patients in an institution for mental disease (IMD).

b. This eligibility for CHIP only applies for the initial conversion to MAGI rules.

c. When reviewing eligibility at the end of the one year of CHIP coverage, the child must meet all of the CHIP eligibility criteria.