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

 Stanley’s Medicaid household income of $2,500/month for a household size of 3 exceeds the maximum of $822/month, so Stanley is not eligible for Medicaid based on MAGI. But he may be eligible for premium tax credits and cost sharing reductions through the Marketplace.

 TRENT (Stanley’s son):  Nebraska’s Medicaid income standard for children ages 6 to 18 is 133% FPL, and the CHIP standard is 213% FPL.  With a Medicaid/CHIP household income of 154% FPL, Trent is not eligible for Medicaid. However, he is eligible for CHIP because he is uninsured and his FPL percentage is below the CHIP income standard.

 JACOB (Stanley and Kelly’s son):  Nebraska’s Medicaid income standard for children ages 1 to 5 is 145% FPL, and the CHIP standard is 213% FPL.  With a Medicaid/CHIP household income of 174% FPL, Jacob is not eligible for Medicaid. However, he is eligible for CHIP because he is uninsured and his FPL percentage is below the CHIP income standard. Notes:  If Kelly and Stanley were married and filing jointly, the tax household would include all family members – Kelly, Stanley, Isaac, Trent, and Jacob – and the Medicaid/CHIP household would be the same as the tax household.  If Kelly and Stanley were married and filing separately, each would be included in the other’s household. Kelly’s Medicaid household would be her tax household + Stanley, and Stanley’s Medicaid household would be his tax household + Kelly.

SIMPLIFIED EXAMPLE 4 – DOUG’S FAMILY

Doug is a 50-year-old man applying for coverage for himself, his 18-year-old daughter Elizabeth, Elizabeth’s 19-year-old husband Andrew, and Andrew and Elizabeth’s 1-year-old son Samuel. Doug claims Elizabeth as a tax dependent, and Andrew claims Samuel as a tax dependent. All of the family members live together. No one in the household is blind or disabled. No one in the household has health insurance. Elizabeth is pregnant and is expecting twins. When the twins are born, Andrew expects to claim himself, Samuel, and the twins as tax dependents (Doug will continue to claim Elizabeth as a tax dependent, as she is still a minor).

Relevant Information:  Doug earns $2,000/month ($24,000/year)  Andrew earns $2,083/month ($25,000/year)  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 Medicaid income standard for children ages 1 through 5 is 145% FPL  Nebraska’s CHIP income standard is 213% FPL  Nebraska’s Medicaid income standard for pregnant women is 194% FPL