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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 1 DEPARTMENT OF HEALTH AND SOCIAL SERVICES Division of Social Services 16000 Financial Methodologies - Application of Modified Adjusted Gross Income (MAGI) Methodology This section implements section 1902(e)(14) of the Social Security Act and describes the modified adjusted gross income (MAGI) methodology used to determine household composition and family size and how income is counted for the financial eligibility determination of modified adjusted gross income (MAGI)-related eligibility groups in accordance with the Affordable Care Act of 2010. 16100 Definitions The following words and terms, when used in the context of these policies, will have the following meaning unless the context clearly indicates otherwise. "Child" means a natural or biological, adopted, or step-child. "Family size" means the number of persons counted as members of an individual’s household. When determining the family size of a pregnant woman, the pregnant woman is counted as herself plus the number of children she is expected to deliver. When determining the family size of other individuals who have a pregnant woman in their household, the pregnant woman is counted as herself plus the number of children she is expected to deliver. "Federal Poverty Level" means the Federal poverty level updated periodically in the Federal Register by the Secretary of the United States Department of Health and Human Services that is in effect for the budget period used to determine an individual’s eligibility in accordance with this section. "Household income" means the sum of the MAGI-based income of every individual included in the individual’s household unless an exception applies. Exceptions: The MAGI-based income of an individual who is included in the household of his or her parent and who is not expected to be required to file a tax return for the taxable year in which eligibility is being determined, is not included in the household income whether or not the individual files a tax return. The MAGI-based income of a tax dependent, claimed by someone other than a parent, who is not expected to be required to file a tax return for the taxable year in which eligibility is being determined, is not included in the household income of the taxpayer whether or not such tax dependent files a tax return. "Modified adjusted gross income (MAGI)" means the adjusted gross income reported on the Internal Revenue Service (IRS) Form 1040 with the addition of: (1) Foreign earned income excluded from taxes (2) Tax-exempt interest (3) Tax-exempt Social Security income "MAGI-based income" means income calculated using the same financial methodologies used to determine modified adjusted gross income as defined in section 36B(d)(2)(B) of the Internal Revenue Service Code, with the following exceptions: (1) An amount received as a lump sum is counted as income only in the month received. (2) Gambling winnings less than $80,000 are counted in the month received; Winnings of $80,000 but less than $90,000 are counted as income over two months, with an equal amount counted in each month. For every additional $10,000 one month is added to the period over which total winnings are divided, in equal installments, and counted as income. The maximum period of time over which winning may be counted is 120 months. Under section 53103(b)(2) of the BBA of 2018 the requirement to count qualified lottery and gambling winnings in household income over multiple months applies only to the individuals receiving the winnings. The determination of household income for other members of the individual’s household are not affected. For example: the total amount of qualified lottery or gambling winnings of a spouse or parent continues to count only in the month received in determining the eligibility of the other spouse and children. (3) Scholarships, awards, or fellowship grants used for education purposes and not for living expenses are excluded from income. (4) American Indian/Alaska Native income as defined in 42 CFR 435.603(e)(3) is excluded. "Parent" means a natural or biological, adopted, or step-parent. "Qualifying child" To be a dependent, a person must be either a qualifying child or a qualifying relative. Generally, a person is a qualifying child if that person:

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