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Job Aid Member Coverage Desciptions Version 1.0

8 © 2024 Gainwell Technologies. All rights reserved. Coverage Coverage Description Coverage Level 074 – Children age 6-19 with income above the MAGI Children Age 6 to 19 between 107% FPL and 133% FPL (no asset test). Effective 01/01/2014, ACA raised income limit to 133% FPL creating new "quasi-CHIP" category (children would have been CHIP prior to ACA). No MAGI-equivalent limit; ACA set limit to 133% FPL. Children to age 19 (eligibility ends the month the child turns age 19) This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 075 - Parents and Caretakers of minor children Coverage extends to one or two parent households with dependent children. Parent(s) or a needy caretaker relative and his/her spouse are covered by Medicaid in this category provided they have minor children under age 18 living in the home. Eligibility is based on household income only - no asset test. Low-income pregnant women are also covered in this category. Families terminated due to earnings qualify for 12 additional months of coverage. Families terminated due to increased spousal support qualify for 4 months (not 12 months) additional coverage. Low-income adults w/ minor children under age 18. Income limits unchanged since 1985 at which time the standard was 50% of the poverty level; however, the ACA required income limits to be adjusted to MAGI-equivalent limits to allow for pre-ACA deductions discontinued by the ACA. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 088 – Pregnant Women Pregnant Women/Infants to age 1 under 185% of Poverty - Eligibility based on household income only - no asset test. Pregnant women remain eligible 2 months postpartum. Effective 01/01/2014, MAGI- equivalent limit = 194% FPL. Pregnant females of any age. Infants to age 1. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 093 – Cost of Living Eligible for SSI but for cost-of-living increase(s) in Social Security. Resource limits same as SSI. Aged, blind and disabled Individuals. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 094 - Disabled Adult Child (DAC) Eligible for SSI but for increase in DAC Social Security benefits. Resource limits same as SSI. Disabled Individuals age 18 and over. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 095 – Widow(er) 60+ years OBRA-87 - Widow(er)s - eligible for widow(er) benefits but not Medicare. Resource limits same as SSI. Aged 60-65 Disabled Widow/ers. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits