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DMA ADMINISTRATIVE LETTER NO: 06-13, MAGI-MEDICAID/nchc HOUSEHOLD DETERMINATION

DATE: August 29, 2013

SUBJECT: Determining Household Composition when applying Modified Adjusted Gross Income (MAGI) Methodology.

DISTRIBUTION: County Directors

Medicaid Supervisors

Medicaid Eligibility Staff

I. Background

ii. Policy principles

III. definition of terms

Medicaid Aged child-Natural, adopted, or stepchild under the age of 19.

iV. magi Household

V. procedures-determining MAGI household composition

vI. examples-contructing the MAGI household

.

Household determination

VII. eFFECTIVE DATE AND IMPLEMENTATION

If you have any questions regarding this information, please contact a Medicaid Program Representative.

Carol H. Steckel, MPH

Director

(This material was researched and written by Ena Lightbourne, Policy Consultant, Medicaid Eligibility Unit)

MAGI ~ Household Composition

1

2

3

4

5

6

Will Applicant/

beneficiary file Taxes?

Yes

Will applicant/

beneficiary be a tax dependent for anyone else?

No

Will Applicant/

beneficiary file Taxes?

No

Will applicant/

beneficiary be a tax dependent for anyone else?

Yes

Does the Applicant/

beneficiary meet any of the exceptions*?

No

Will Applicant/

beneficiary file Taxes?

Yes

Will applicant/

beneficiary be a tax dependent for anyone else?

Yes

Does the Applicant/

beneficiary meet any of the exceptions*?

No

Will Applicant/

beneficiary file Taxes?

No

Will applicant/

beneficiary be a tax dependent for anyone else?

No

Will Applicant/

beneficiary file Taxes?

No

Will applicant/

beneficiary be a tax dependent for anyone else?

Yes

Does the Applicant/

beneficiary meet any of the exceptions*?

Yes

Will Applicant/

beneficiary file Taxes?

Yes

Will applicant/

beneficiary be a tax dependent for anyone else?

Yes

Does the Applicant/

beneficiary meet any of the exceptions*?

Yes

Tax HH: HH is applicant, co-filer spouse and a/b’s tax dependents. Include live in spouse if not included in tax HH.

Tax HH: HH is tax filer’s household claiming a/b as a dependent. Include a/b’s live-in spouse if not included in tax HH.

Non-Filer HH: HH is applicant/beneficiary, spouse in the home, and their children in home under age 19.

If applicant/beneficiary is under age 19: Also includes: live-in parent(s) and live-in siblings under age 19

*EXCEPTIONS: Is the applicant/beneficiary:

1. A tax dependent of someone other than spouse or parent?

2. Under age 19 and living with both parents who will not file jointly?

3. Under age 19 and will be claimed by a non-custodial parent?

Types of Medicaid/NCHC MAGI Households

Tax Household – Used as Medicaid/NCHC when applicant/beneficiary is tax filer or tax dependent and no exceptions apply. The household includes:

      • Tax Filer(s)

      • Tax Dependents of Tax Filer(s)

      • Spouse of applicant/beneficiary, if in the home and not in the tax household

Non-filer household – Used when applicant/beneficiary is not tax filer or tax dependent or meets one of the exceptions. The household includes:

      • Individual, and if living in the home:

      • Individual’s spouse

      • Individual’s natural, adoptive and step children under age 19

    If individual is under age 19, includes same as above AND

      • Individual’s natural, adoptive and step parent(s) in the home

      • Individual’s natural, adoptive and step siblings in the home under age 19

Pregnant Women

NOTE: Under either type of household (tax or non-filer), when a pregnant woman is the applicant/beneficiary, always include the unborn(s) in her household when determining her eligibility for any MAGI program. When the pregnant woman is a household member of another applicant/beneficiary, include only the PW – do not add the unborn(s).

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