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All County Welfare Directors Letter No.: 20-10 Page 2 April 30, 2020
The household composition rules outlined in this letter apply to all MAGI Medi-Cal coverage groups below: • New Adult Group (adults aged 19 to 64 and not Medicare eligible); • Parent/Caretaker Relative Group (including pregnant individuals in their third trimester); o Note: California Work Opportunity and Responsibility for Kids (CalWORKS) parents/caretaker relatives are covered under this eligibility group • Mandatory Children’s Groups • Optional Targeted Low-Income Children’s Program (OTLICP); • Pregnant Women and Infant programs; • Medi-Cal Access Program (MCAP); and • Medi-Cal Access Infant-Linked Program (MCAIP)
The following policy areas will be included in this ACWDL. Due to the size of this ACWDL, the corresponding page numbers have been included next to the subject title for navigation purposes. • I. MAGI Medi-Cal Household Composition and Tax Filing Rules Page 02 • II. Required Tax Filing Information for MAGI
Page 06 • III. Obtaining and Verifying Tax Filing Information Page 07 • IV. MAGI Medi-Cal Household Composition Scenarios
Page 10 • V. Complex Households and Special Populations
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I. MAGI Medi-Cal Household Composition and Tax Filing Rules MAGI Medi-Cal follows the federal tax filing rules as a framework to determine an individual’s MAGI Medi-Cal household composition based on their tax filing status (42 C.F.R. Section 435.603).
DHCS, in coordination with the Centers for Medicare & Medicaid Services (CMS), created a MAGI Medi-Cal Household Size Flowchart for use when calculating MAGI Medi-Cal household compositions. Counties may use the “DHCS MAGI Household Size Flow Chart” when constructing an individual’s MAGI Medi-Cal household composition. In addition, CalHEERS uses the same flowchart to determine MAGI Medi-Cal household compositions.
MAGI methodology requires the construction of MAGI Medi-Cal household compositions to be on an individual basis for each household member, because in some situations, there is the potential for each individual in the household to have a