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MACStats: Medicaid and CHIP Data Book 101 Section 4: Medicaid and CHIP Eligibility MACStats Section 6 Section 3 Section 5 Section 2 Section 4 Section 1 MACStats Section 4 EXHIBIT 36. (continued) State Parents and caretaker relatives of dependent children1 Additional individuals age 19–642 Pennsylvania 33% 133% Rhode Island 116 133 South Carolina 95 – South Dakota 46 133 Tennessee 100 – Texas 12 – Utah 366 1333 Vermont 43 133 Virginia 49 133 Washington 33 133 West Virginia 16 133 Wisconsin 95 953 Wyoming 45 – Notes: As of January 2024, 100 percent of the federal poverty level (FPL) in the lower 48 states and the District of Columbia was $15,060 for an individual plus $5,380 for each additional family member. Before 2014, states had the flexibility to disregard income sources and amounts of their choosing when determining Medicaid and CHIP eligibility. In 2014, uniform modified adjusted gross income (MAGI) rules became mandatory for determining Medicaid and CHIP eligibility for most children and adults under age 65 eligible for Medicaid on a basis other than disability, including the groups shown in this table. As a result, states are now required to use MAGI-converted eligibility levels that account for the change in income- counting rules. The eligibility levels shown in this table reflect these MAGI-converted levels or another MAGI-based income limit in effect in each state for these groups as of July 2024. Under federal regulations, the effective income limits may be 5 percentage points higher than the percentage of FPL shown in this table to account for a general income disregard that applies to an individual’s eligibility under the group with the highest income standard, rather than for particular eligibility groups within Medicaid or CHIP. States are required to provide Medicaid coverage for parents and other caretaker relatives (and their dependent children) at or above the state's 1988 Aid to Families with Dependent Children eligibility levels. Under regular Medicaid state plan rules, states may opt to cover additional parents and caretaker relatives, children age 19 to 20, and other individuals age 19 through 64 who have incomes less than or equal to 133 percent FPL and are not pregnant or eligible for Medicare. Certain states provide coverage through Section 1115 waivers, which allow them to operate their Medicaid programs with fewer statutory requirements. As noted in this table, the covered benefits under these waivers may be more limited than those provided under regular state plan rules and might not be available to all individuals at the income levels shown. – Dash indicates that state does not use this eligibility pathway. ¹ In states that use dollar amounts rather than percentage of FPL to determine eligibility for parents, dollar amounts were converted to percentage of FPL, and the highest percentage was selected to reflect eligibility level for the group. Parents and caretaker relatives with income above the reported threshold for this group may be eligible for coverage under the new adult group (under Section 1902(a)(10)(A)(i)(VIII) of the Social Security Act (the Act)) in states that have adopted the expansion. ² Reflects state plan coverage under Section 1902(a)(10)(A)(i)(VIII) of the Act for individuals who are age 19 through 64, have incomes less than or equal to 133 percent FPL, and are not pregnant or eligible for Medicare; state plan coverage for children age 19 to 20 where indicated; and Section 1115 waiver coverage that is not subject to the limitations indicated in note 5. ³ The state has a Section 1115 demonstration that provides Medicaid coverage to some low-income adults. In some cases, the demonstration includes limitations on eligibility or benefits, is not offered to all residents of the state, or includes an enrollment cap. ⁴ In Minnesota and Oregon, individuals with incomes that are greater than 133 percent FPL but do not exceed 200 percent FPL are covered under the Basic Health Program. 5 In New York, individuals with incomes that are greater than 133 percent FPL but do not exceed 250 percent FPL are covered under the Essential Plan Expansion using a Section 1332 waiver.