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MEDICAL SERVICES POLICY MANUAL,SECTION E E-200 Determining Financial Eligibility Under the MAGI Methodology

E 210 What is MAGI?

E-200 Determining Financial Eligibility Under the MAGI Methodology

E-210 What is MAGI? MS Manual 08/03/2020 MAGI is a federal income tax term meaning Modified Adjusted Gross Income. For purposes of determining Medicaid eligibility, MAGI is a methodology for determining how income is counted and how household composition and family size are determined. It is based on federal tax rules, but it is not an amount on a specific line on an individual federal tax return. In addition to being used to determine Medicaid eligibility for certain eligibility groups, the MAGI methodology is also used to determine eligibility for and the amount of Advance Premium Tax Credits (APTC) and cost-sharing reductions available to individuals and families who are eligible to purchase health insurance through the Federally Facilitated Health Insurance Marketplace (FFM). For tax purposes, the modified adjusted gross income reflects annual income for a specific tax year. For Medicaid purposes, however, current monthly income is used to determine eligibility. This is true even when using MAGI methodologies. Detailed information on determining whether income is “current” and converting income amounts to monthly amounts can be found in MS E-265.

E-220 Families and Individuals (MAGI) Groups MS Manual 08/03/2020 MAGI methodologies are used to determine financial eligibility for the following groups: 1. Infants and children under age 19 (ARKids A & B); 2. Pregnant women; 3. Parents and caretaker relatives; 4. Adults age 19 through 64 who do not fall into another adult group, such as the Adult Expansion Group; or 5. Transitional Medicaid.