101.02.04 OPTIONAL CATEGORICALLY NEEDY – MAGI-RELATED

Optional Coverage of Foster and Adoption Assistance Children The Department of Child Protection Services (DCPS) certifies eligibility for the following optional groups of children who are in the custody of DCPS: • Children under the age of 21 for whom the Department of Child Protection Services (DCPS) assumes full or partial financial responsibility who are in foster homes or private institutions are certified for Medicaid coverage by DCPS if the child’s income is within state established standards, converted to a MAGI-equivalent standard. • Children under age 21 in adoptions subsidized in full or part by DCPS and children in adoption assistance who cannot be placed for adoption without medical assistance due to special needs of the child are eligible for Medicaid regardless of the child’s income, as determined by DCPS. Optional Coverage of the Children’s Health Insurance Program (CHIP) The Division of Medicaid certifies eligibility for the Children’s Health Insurance Program (CHIP). Uninsured children under age 19 whose household income is at or below 200% of the federal poverty level converted to a MAGI-equivalent standard are covered by CHIP, which is a separate health plan. Covered children include: • Infants to age one (1) whose household income is between the MAGI equivalent standards of 185% - 200% of the federal poverty level; • Children age one (1) to age six (6) whose household income is between the MAGI-equivalent income standards of 133% - 200% of the federal poverty level; and, • Children age six (6) to age nineteen (19) whose household income is above 133% of the federal poverty level but below the MAGI-equivalent income standard of 200%. Optional Presumptive Eligibility for Pregnant Women Determined by Qualified Providers • Qualified providers are allowed to determine presumptive eligibility for individuals eligible for Medicaid in the pregnancy coverage group (COE 88), referred to as Presumptive Eligibility or Pregnant Women or PEP. PEP allows qualified, registered providers to immediately enroll pregnant patients in Medicaid who are determined eligible for Medicaid by authorized provider staff. PEP provides temporary Medicaid eligibility but also allows access to continuing Medicaid coverage provided the PEP decision includes filing a full Medicaid application. • The Medicaid coverage group eligible for PEP decision is limited to pregnant women. The Division of Medicaid is responsible for PEP Medicaid in conjunction with qualified providers that certify PEP eligibility. Optional Waiver Coverage – Family Planning Section 1115 waiver coverage provides family planning and family planning related services to certain individuals who have family income at or below 185% of the federal poverty level converted to a MAGI-equivalent standard of federal poverty level. Waiver eligibility requirements include the following: • Women and men, ages 13 – 44, may qualify for waiver participation. • Waiver participants may not be otherwise eligible for Medicare, Medicaid, CHIP or other health insurance that includes coverage of family planning services. • Individuals who have had surgery to prevent reproduction cannot qualify for waiver participation, • MAGI non-filer household rules are applied to family income, excluding any non-taxable income sources. Applicants under the age of 19 are budgeted as a household of one with parental and other income disregarded. The Division of Medicaid determines eligibility for participation in the Family Planning Waiver.