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REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-006

 Bob’s Medicaid household income of $4,500/month for a household size of 2 exceeds the maximum of $704/month, so Bob is not eligible for Medicaid based on MAGI. But he may be eligible for premium tax credits and cost sharing reductions through the Marketplace.

 SOPHIA:  Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL, and the CHIP standard is 213% FPL.  Sophia’s Medicaid/CHIP household income of 348% FPL exceeds the FPL percentage for both Medicaid and CHIP, so Sophia is not eligible for Medicaid or CHIP based on MAGI. But she may be eligible for premium tax credits and cost sharing reductions through the Marketplace.

 EMMA:  Nebraska’s Medicaid income standard for children ages 1 through 5 is 145% FPL, and the CHIP standard is 213% FPL.  With a Medicaid/CHIP household of 23% FPL, Emma is eligible for Medicaid. If Emma had not been eligible for Medicaid, she may have been eligible for CHIP because she is uninsured and her FPL percentage is below the CHIP income standard.

SIMPLIFIED EXAMPLE 2 – ALICE & BILL

Alice is a 66-year-old working grandmother who is applying for coverage for herself and her 12- year-old grandson Bill, who lives with Alice. Alice does not plan to claim Bill as a tax dependent. Bill receives Social Security Survivor benefits, which count as income. Bill is not expected to file taxes. Alice and Bill are not blind or disabled, but Alice is age 65 or older. No one in the household is pregnant. Alice receives Medicare benefits; Bill has no health insurance.

Relevant Information:  Alice earns $850/month ($10,200/year)  Bill receives $500/month in Social Security Survivor benefits  There are no other sources of income  Tax filing threshold: Tax dependents with more than $6,300* per year of earned income must file taxes.  Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL  Nebraska’s CHIP income standard is 213% FPL

* Federal Poverty Levels and federal tax filing thresholds are subject to change yearly.

1. CONSTRUCT A MEDICAID/CHIP HOUSEHOLD FOR EACH APPLICANT.

 ALICE expects to file taxes and she does not expect to be claimed as a tax dependent. However, because Alice is 66 years old, her eligibility for Medicaid will be based on ABD standards, in which tax filing requirements do not apply and eligibility is determined using non-MAGI ABD based methodology. Thus, at this point, we will discontinue any efforts to determine MAGI-based eligibility for Alice. To determine if Alice is eligible for Medicaid, she will have to provide more information on a supplemental form for ABD benefits.