101.02.01 MANDATORY CATEGORICALLY NEEDY – MAGI RELATED

The following are MAGI-related coverage groups that must be covered, as required by federal law: Mandatory Coverage of Parents and Other Caretaker Relatives Coverage is mandatory for parents and other caretaker relatives who have a dependent child or children under the age of eighteen (18) living in the home whose household income is below the applicable limit established by the state for coverage. The limit established by the state is a MAGI-equivalent standard based on household size. The Division of Medicaid certifies eligibility for this group. • Extended Medicaid coverage for twelve (12) months is mandatory for a family whose eligibility is based on family coverage if the family loses Medicaid coverage solely due to increased income from employment or increased hours of employment provided the family received Medicaid in any three (3) or more months during the six (6) month period prior to becoming ineligible, as determined by the Division of Medicaid. Mandatory Coverage of Pregnant Women Coverage is mandatory for pregnant woman whose household income is at or below the income standard established by the state, not to exceed 185% of the federal poverty level converted to a MAGI-equivalent standard. The Division of Medicaid certifies eligibility for this group. • DOM must provide Medicaid for an extended period following termination of pregnancy to women who applied for and were eligible and received Medicaid services on the day that their pregnancy ends. This period extends from the last day of pregnancy through the end of the month in which a 12-month period ends. • Eligibility must be provided regardless of changes in the woman’s financial circumstances that may occur within this extended period. • A review is required at the end of the 12-month period. Mandatory Coverage of Newborns Coverage is mandatory for infants born to Medicaid eligible mothers. The infant is deemed eligible for one (1) year from the date of birth. This provision applies in instances where the labor and delivery services were furnished prior to the date of application and covered by Medicaid based on retroactive eligibility. The Division of Medicaid is responsible for certifying eligibility for deemed eligible newborns. Coverage is mandatory for infants born to qualified or non-qualified alien mothers who qualify for Medicaid on all factors other than alien status who receive Medicaid based on emergency medical services, provided an application for emergency services is timely filed with the Division of Medicaid. Mandatory Coverage of Infants and Children under Age 19 Coverage is mandatory for the following age-specific groups of children certified by the Division of Medicaid: • Infants to age 1 in households whose income is at or below 185% of the federal poverty level converted to a MAGI-equivalent standard. • Children age 1 to age 6 whose income is at or below 133% of the federal poverty level converted to a MAGI-equivalent standard. • Children age 6 to age 19 are eligible for Medicaid if household income is at or below 133% of the federal poverty level. This limit is not converted to a MAGI-equivalent because federal law specifies 133% as the maximum limit. Mandatory Coverage of Adoption Assistance and Foster Care Children Coverage is mandatory for children for whom adoption assistance or foster care maintenance payments are made under title IV-E of the Social Security Act, as determined by the Department of Child Protection Services who certifies eligibility for this group of children. Mandatory Coverage of Former Foster Care Children Coverage is mandatory for former foster care children who are under age twenty-six (26) if the child was in foster care and Medicaid upon reaching the age of 18 or prior to age 21 when released from foster care. Continued Medicaid coverage is certified by the Division of Medicaid in coordination with the Department of Child Protection Services.