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DMA ADMINISTRATIVE LETTER NO: 06-14, MAGI-HOUSEHOLD DETERMINATION AND 5% INCOME DISREGARD

DATE: October 30, 2014

SUBJECT: MAGI-Household Determination and 5% Income Disregard

DISTRIBUTION: County Directors

Medicaid Supervisors

Medicaid Eligibility Staff

I. BACKGROUND

II. Overview of changes

iiI. policy principles

iV. dEFINITION OF TERMS

V. What income can be counted

Income

Traditional Medicaid Rules

MAGI Medicaid Rules

Salary Deferrals (flexible spending, cafeteria, 401 (k) plans and other pre- tax retirement contributions)

Counted

Not Counted

Child Support

Counted

NOT COUNTED

Veterans benefits

COUNTED

NOT COUNTED

Worker’s compensation

COUNTED

NOT COUNTED

GIFTS AND INHERITANCES

COUNTED AS LUMP SUM IN THE MONTH RECEIVED

NOT COUNTED

Deductions/Disregards

Traditional Medicaid rules for Deductions

MAGI Medicaid rules for Deduction

Alimony paid

Only deducted from income when court-ordered

Deducted from income

Earned Income Deduction (27.5%)

Deducted from income

Not deducted from income

Federal and State Earned income Tax Credit (EITC)

Deducted from income

Not deducted from income

Standard Work deduction ($90)

Deducted from income

Not deducted from income

Child/Adult care deduction

Deducted from income

Not deducted from income

Self-Employment

Limited deductions for some business expenses.

Deductions for most expenses, including depreciation and business losses as allowed by federal tax rules.

Job Bonus

100% earned income disregard

Not Disregard

5% Income Disregard

N/A

Deducted from total countable income if income exceeds the limit for Medicaid. If ineligible for full Medicaid, deduct when evaluating for NCHC, Family Planning and MPW if income exceeds those limits.

Vi. Whose income counts when determing household income

Counting Income Tax Household

 

Tax Filer(s)

Tax Dependent – child of tax filer – does not meet an exception

Tax Household

Count income of tax filer and co-filer spouse. Include live in spouse’s income if not already included in tax HH.

Only count income of tax dependents who expect to file a tax return.

Count income of tax filer(s)

Count income of the tax dependent applicant, and other tax dependents who expect to file a tax return. Count the income of the tax dependent’s spouse if not included in the tax household.

Counting Income Non Filer

 

Tax Dependent – not child of tax filer

(non-filer rules)

Adult – age 19 or older

Medicaid age child – under age 19

Non-filer rules

Count income for own household regardless of whether they expect to file taxes and count income of live-in spouse.

If the tax dependent has children under age 19 in the household, count income of children under age 19 if they expect to file return.

If the tax dependent is under age 19 ( see last column for Medicaid age child-under age 19)

Count income of applicant and spouse, if in home.

Count income of children in household under 19 only if expect to file return

If parent(s) is not in the household count income for own household regardless of whether they expect to file taxes and count income of live in spouse and live in siblings under age 19.

If the Medicaid age child has children under age 19, count income of children under age 19 if expect to file return.

If parent(s) is in the household, count the income of the parent(s). Do not count income of the child and siblings under age 19 unless they expect to file a tax return.

vii. Procedures- Determining the household income for each individual

Viii. Examples-Determining the household income for each household

    applicant

MAGI Household

Annie

Jacob

Miley

Family Size

Countable

Income

Eligibility

Annie

    x

    x

    x

    3

    $648.54

    MAF-C

Jacob

    x

    x

    x

    3

    $731.00

    MIC-N

Miley

    x

    x

    x

    3

    $731.00

    MIC-N

    applicant

MAGI

Household

Mary

Bill

Ned

Nancy

Family Size

Countable

Income

Eligibility

Mary

    x

    x

    x

    x

    4

    $700.62

    MAF-C

Bill

    x

    x

    x

    x

    2

    $800.00

    MAF-D

Ned

   

    x

    x

    2

    $1460.00

    MIC-1

Nancy

   

    x

    x

    2

    $1460.00

    MIC-1

    Applicant

MAGI Household

Carol

Marcia

Lily

Family Size

Countable

Income

Eligibility

Carol

    x

    x

    x

    3

    $607.54

    MAF-C

Marcia

    x

    x

    x

    3

    $690.00

    MIC-N

Lily

 

    x

    x

    2

    $0

    MAF-C

    Applicant

MAGI

Household

Rose

Alice

Kitty

Family Size

Countable Income

Eligibility

Rose

    x

    x

 

    2

    $1560.00

    MAF-D

Alice

    x

    x

 

    2

    $1560.00

    MIC-1

Kitty

 

    x

    x

    2

    $0

    MAF-C

$721.00/monthly-Jason’s Supplement Security income (SSI)

    applicant

MAGI Household

Whitney

Paul

Jason

Family Size

Household income

Eligibility

Whitney

    x

    x

    x

    3

    $617.54

    MAF-C

Paul

    x

    x

    x

    3

    $700.00

    MIC-N

Jason

     

    SSI recipient

   

Ix. eFFECTIVE DATE AND IMPLEMENTATION

If you have any questions regarding this information, please contact an Operational Support Team Representative.

Robin G. Cummings, M.D. 

Director

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

MAGI MEDICAID INCOME LIMITS

*** MAGI groups do not have Reserve Limits – Only MAF-M group ***

Revised effective 4/1/2014

Family & Children’s MA

1

2

3

4

5

6

7

8

9

10

Add’l

196% MPW

1907

2570

3233

3896

4559

5222

5885

6549

7212

7875

664

195% MAF-D

1897

2557

3216

3876

4536

5196

5855

6515

7175

7835

660

194%-210% MIC-1<1

1887.01-2043

2544.01-2753

3200.01-3464

3856.01-4174

4513.01-4885

5169.01-5595

5825.01-6306

6482.01-7016

7138.01-7727

7794.01-8437

711

194% MIC-N <1

1887

2544

3200

3856

4513

5169

5825

6482

7138

7794

657

141%-210% MIC-1
(Age 1-5)

1372.01-2043

1849.01-2753

2326.01-3464

2803.01-4174

3280.01-4885

3757.01-5595

4234.01-6306

4711.01-7016

5188.01-7727

5665.01-8437

711

141% MIC-N (Age 1-5)

1372

1849

2326

2803

3280

3757

4234

4711

5188

5665

478

107%-133% MIC-1
(Age 6-18)

1041.01-1294

1403.01-1744

1765.01-2194

2127.01-2644

2489.01-3094

2851.01-3544

3213.01-3994

3575.01-4444

3937.01-4894

4299.01-5344

450

107% MIC-N
(Age 6-18)

1041

1403

1765

2127

2489

2851

3213

3575

3937

4299

363

MAF-C/N

434

569

667

744

824

901

975

1036

1096

1169

78

Reserve:

MAF-M

3000

3000

3000

3000

3000

3000

3000

3000

3000

3000

3000

NC Health Choice

1

2

3

4

5

6

7

8

9

10

Add’l

133%-159% MIC-J
(Age 6-18)

1249.01-1547

1744.01-2085

2194.01-2623

2644.01-3161

3094.01-3699

3544.01-4237

3994.01-4774

4444.01-5312

4894.01-5850

5344.01-6388

538

>159%-211% MIC-K
(Age 6-18)

1547.01-2052

2085.01-2766

2623.01-3480

3161.01-4194

3699.01-4908

4237.01-5622

4774.01-6336

5312.01-7050

5850.01-7764

6388.01-8477

714

MAGI disregard

1

2

3

4

5

6

7

8

9

10

Add’l

FPL 5% DISREGARD

48.63

65.54

82.46

99.38

116.29

133.21

150.13

167.04

183.96

200.88

16.92

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