Page 7

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

 SAMANTHA:  Nebraska’s Medicaid income standard for children ages 6 through 18 is 133% FPL, and the CHIP standard is 213% FPL.  Samantha’s Medicaid/CHIP household income of 277% FPL exceeds the FPL percentage for both Medicaid and CHIP, so Samantha 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. The agency will electronically transfer the account, including all relevant information, to the Marketplace for further evaluation.

 JOY:  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, Joy is eligible for Medicaid. If Joy 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 1 – BOB & FAMILY

Bob is a 58-year-old working grandfather. Bob’s daughter Sophia, age 18 and a full-time student, and Sophia’s daughter Emma, age 2, live with Bob. Bob claims Sophia as a tax dependent but Emma is claimed as a tax dependent by her non-custodial parent Harold, who does not live with Bob. Bob, Sophia, and Emma are not blind or disabled. No one in the household is pregnant. No one has health insurance

Relevant Information:  Bob earns $4,500/month ($54,000/year)  Sophia earns $300/month ($3,600/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 Parent/Caretaker Relative income maximum is:

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

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