All Medicaid Programs |
Obsolete Policy |
Effective Date: September 1, 2016 - October 31, 2017 (340 was renumbered to 232 as of November 1, 2017)
"Modified Adjusted Gross Income," or MAGI
The term "Modified Adjusted Gross Income," or MAGI, refers to a methodology of determining if an individual is eligible for medical assistance. It is used for the following eligibility groups:
Parents and other caretaker relatives
Pregnant women
Children under age 19
Non-title IV-E foster children
Individuals infected with tuberculosis
Primary Care Network
Utah's Premium Partnership
Non-MAGI Groups
The MAGI methodology does not apply when determining eligibility for the following eligibility groups:
Individuals age 65 and older when age is the basis of eligibility.
Individuals who are blind or disabled when determining eligibility for the blind or disabled eligibility groups.
The Medicare Cost-Sharing programs.
Individuals in any category who are eligible for a medically needy eligibility group.
Individuals applying for nursing home eligibility.
Individuals who are applying for waiver services.
Individuals for whom an income determination is not required including the breast and cervical cancer program, the Former Foster Care Children, Foster Care Independent Living Program, state subsidized foster care, Title IV-E children, and Refugee Medical Assistance.
The MAGI methodology is not used by entities making presumptive eligibility decisions.
The following sections will define the MAGI methodology and the eligibility groups for which it is used.
Continued Coverage for Pregnant Women
A woman who, while pregnant, receives coverage under any Medicaid program, will remain eligible for Medicaid for the duration of her pregnancy and through the end of the month in which the 60-day post-partum period ends. She must still be a Utah resident and not be a resident of a public institution. It may require that she change coverage groups, but do not require a new income redetermination to move her to a different coverage group.
Example: If a woman becomes pregnant while on the Child program, she should transition to the Pregnant Woman program if she turns 19 during the pregnancy.
A pregnant woman who has a change in her household income will continue to receive coverage without regard to such change of income for the duration of her pregnancy and through the completion of the month in which the 60-day post-partum period ends. If needed, move the woman to the MAGI-based Pregnant Woman program for the duration of the pregnancy and post-partum period without conducting a new income determination.
A pregnant woman who is determined to be eligible for the Pregnant Woman Medically Needy program, must pay a spenddown each month to remain eligible for coverage under that program.
If the woman’s income increases, the spenddown amount cannot increase above the amount that was originally calculated when the program was approved.
If income decreases below the poverty limit for pregnant women, move her to the MAGI-based pregnant woman program (349).