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When applying for Medicaid coverage, an applicant’s AG is defined differently depending on the category of assistance under which he or she is being considered for eligibility. An applicant’s AG may change as the application moves through the Medicaid eligibility hierarchy and she is considered for different eligibility categories. Some categories are subject to MAGI methodology for determination of the applicant’s AG, and some are not.

The ACA did not change the AG determination rules for applicants being considered for eligibility for a non-MAGI category of assistance.

3205.05.00 MAGI ASSISTANCE GROUP DEFINITION

The types of individuals who would be likely to be considered for eligibility under categories of assistance subject to the MAGI household size (AG) determination methodology are as follows:

• Children under one year of age (MA Y) • Children one to five years of age (MA Z) • Children six to nineteen years of age (MA 2, MA 9, MA 10) • Children between nineteen and twenty-one residing in an inpatient psychiatric facility (MA O) • Parents or caretaker relatives (MAGF); Pregnant women (MAGP) • Family Planning Services (MA E).

For eligibility under the Healthy Indiana Plan for uninsured adults between ages 19 and 64, please, refer to IHCPPM Chapter 3500.

A child or adult who is disabled or blind and applying for Medicaid coverage will also be considered for eligibility under a category of assistance that is not subject to MAGI household size (AG) determination rules. Additionally, children under the age of 19 with adoptive assistance, foster children, and former foster children up to age 26 who were enrolled in Medicaid on their 18th birthday are eligible under categories of assistance that are not subject to MAGI household size (AG) determination rules.

Under MAGI methodology, the basic rules for who is counted as part of the household size (AG) of the applicant are aligned with federal tax filing rules. There are different rules for determining the AG of applicants who are tax filers, applicants who are tax dependents and applicants who are neither tax filers nor tax dependents.

3205.05.05 BASIC MAGI RULES FOR DETERMINING THE AG OF AN INDIVIDUAL WHO IS NEITHER A TAX FILER NOR A TAX DEPENDENT

MAGI Rules CHART https://www.in.gov/fssa/ompp/files/Rules-chart.pdf