Page 1

State of California—Health and Human Services Agency

Department of Health Care Services

BRADLEY P. GILBERT, MD, MPP GAVIN NEWSOM

DIRECTOR GOVERNOR

DATE: April 30, 2020

Letter No: 20-10

TO: ALL COUNTY WELFARE DIRECTORS

ALL COUNTY ADMINISTRATIVE OFFICERS ALL COUNTY MEDI-CAL PROGRAM SPECIALISTS/LIAISONS ALL COUNTY PUBLIC HEALTH DIRECTORS ALL COUNTY MENTAL HEALTH DIRECTORS ALL CONSORTIA/SAWS PROJECT MANAGERS

SUBJECT: GUIDANCE ON MODIFIED ADJUSTED GROSS INCOME (MAGI) MEDI-CAL HOUSEHOLD COMPOSITIONS (Reference: All County Welfare Director’s Letter (ACWDL) 17-16, Medi-Cal Eligibility Division Information Letters (MEDIL) 19-24 and the “DHCS Guide for Calculating MAGI Medi-Cal Individual Household Size (Household Size Flow Chart v1.0 20160826)”).

The purpose of this All County Welfare Directors Letter (ACWDL) is to provide guidance on the construction of Modified Adjusted Gross Income (MAGI) Medi-Cal household compositions, including complex households and special populations, as defined in Title 42 Code of Federal Regulations (C.F.R.) Section 435.603. This ACWDL will review the framework for MAGI Medi-Cal household compositions, how to obtain tax filing information, and how to apply both of these to create a MAGI Medi-Cal household. In addition, this ACWDL will provide scenarios of how to determine MAGI Medi-Cal household compositions for various scenarios including complex households and special situations.

Household composition rules for Covered California programs are also included within the letter. The intent of this information is to assist county eligibility workers (CEWs) with eligibility determinations for all Insurance Affordability Programs.

Background The Affordable Care Act of 2010 (ACA) introduced MAGI-based Medi-Cal, which added a new household composition methodology to determine Medi-Cal eligibility. MAGI Medi-Cal household composition methodology uses federal tax filing rules as a framework to determine the MAGI Medi-Cal household compositions (per 42 C.F.R. Section 435.603).

Medi-Cal Eligibility Division 1501 Capitol Avenue, MS 4607 P.O. Box 997413, Sacramento, CA 95899-7413 (916) 552-9200 phone • (916) 552-9477 fax Internet Address: www.dhcs.ca.gov