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MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI B-100 MAGI MEDICAL CATEGORIES Division of Welfare and Supportive Services Medical Assistance Manual 24 Apr 02 MTL 03/24 OVERVIEW MAGI MEDICAL CATEGORIES B-100 OVERVIEW Eligibility for medical assistance is categorized in groups based on budgeting methodologies associated to the eligibility determination. Family Medical groups - cover individuals, families and children in Medicaid and Nevada Check Up, eligibility is determined using the MAGI budgeting methodologies. These groups have no resource test. Specialized Medical groups - cover individuals in specialized groups such as Aged Out of Foster Care, Rite of Passage, and Breast and Cervical. This group allows for exemptions from income and resource determinations. MAABD groups - cover aged, blind, and disabled individuals using non-MAGI and SSI budgeting methodologies. These groups can have a resource test for some programs. Individuals requesting medical assistance must be evaluated under all potential medical groups including Nevada Check Up prior to being referred to the insurance marketplace. Individuals determined ineligible due to excess income will be referred to the insurance marketplace where they can apply for either a cost- sharing reduction or an advanced premium tax credit they can use to shop for private insurance. Lawful Permanent Residents (LPRs), which are ineligible for Medicaid because they are serving the 5-year bar, may still be eligible to purchase private insurance through the insurance marketplace and may even receive a cost-sharing reduction or an advance premium tax credit. Individuals Pending an SSI Decision If an individual is pending an SSI decision, staff must evaluate the individual’s eligibility for any of the Medicaid groups listed above, including the new childless adult group, until a decision is made by SSA. If the individual is determined to be eligible in another Medicaid group: • approve eligibility under the new Medicaid group in the appropriate month; and • deny the MAABD pending SSI case effective the same month you are approving; and • keep the MAABD SSI pending for months which are not covered by another category, until an SSI decision is received from SSI for those months. A new application is not required to move between a MAGI group and non-MAGI groups. Additional information may be required to complete the conversion. See Conversions section in MAM D-540 for more information. For each individual applying for Medicaid in the household, determine what Medicaid coverage group the individual qualifies for based on the following hierarchy.