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

 Although Samantha is not required to file a tax return, her income counts because neither of her parents is included in this household.  Samantha earns $300/month, so her MAGI-based income = $300/month (B).  The household’s income equals the sum of the MAGI of every member of Joy’s household (C), so Joy’s Medicaid/CHIP household income = $300/month.  This household income equates to 23% FPL* for a household size of 2 for purposes of either a Medicaid eligibility determination for children age 1 through 5 or a CHIP eligibility determination.  JOY’S MEDICAID/CHIP HOUSEHOLD INCOME = 23% FPL.

3. DETERMINE WHETHER EACH INDIVIDUAL IS ELIGIBLE FOR MEDICAID/CHIP, OR WHETHER THEY ARE POTENTIALLY ELIGIBLE FOR THE EXCHANGE/APTC.

 MARY:  Because Mary claims Samantha and Joy, both children, as tax dependents, we determine Mary’s eligibility under the Parent/Caretaker Relative group.  Nebraska’s Parent/Caretaker Relative income maximum is*:

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

 Mary’s Medicaid household income of $4,500/month for a household size of 3 exceeds the maximum of $841/month, so Mary is not eligible for Medicaid based on MAGI. But she may be eligible for premium tax credits and cost sharing reductions through the Marketplace. The agency will electronically transfer the account, including all relevant information, to the Marketplace for further evaluation.

Note: If an applicant indicated they may qualify for Medicaid on a non-MAGI basis, such as being medically needy (share of cost), or having blindness or a disability, the Medicaid agency would pursue such evaluation at the same time as the Exchange completed determination of eligibility for Exchange/APTC. This would require the applicant to supply the Medicaid agency with information on a supplemental form.

By household size/month: 1 - $569 2 - $704 3 - $841 4 - $976 5 - $1,112 6 - $1,247 7 - $1,383 Add- on for each additional family member - $133