NEVADA STATE DIVISION OF SOCIAL SERVICES MEDICAL ASSISTANCE PROGRAM MANUAL APPENDIX A INCOME/RESOURCE CHARTS VERIFICATION PLAN AID CODE CHARTS

MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MAGI INCOME CHART Effective 4/1/2025 Household Size AM limit AM Limit w/Medicare 100% FPL 122% FPL 138% FPL 165% 190% 205% 1 $319 $385 $1,305 $1,592 $1,800 $2,152 $2,478 $2,674 2 $407 $496 $1,763 $2,151 $2,433 $2,909 $3,349 $3,614 3 $495 $607 $2,221 $2,710 $3,065 $3,665 $4,220 $4,553 4 $582 $716 $2,680 $3,269 $3,698 $4,421 $5,091 $5,493 5 $670 $827 $3,138 $3,828 $4,330 $5,177 $5,962 $6,432 6 $758 $938 $3,596 $4,387 $4,963 $5,934 $6,833 $7,372 7 $846 $1,049 $4,055 $4,947 $5,595 $6,690 $7,703 $8,312 8 $934 $1,160 $4,513 $5,506 $6,228 $7,446 $8,574 $9,251 Each Add +88 +111 +$458 $559 $633 $756 $871 $939 MAGI CASH GIFT COUNTABILITY TAX YEAR IRS ANNUAL EXCLUSION MAXIMUM EXCLUSIONS ALLOWED PER PERSON 2002-2005 $11,000 1 2006-2008 $12,000 1 2009-2012 $13,000 1 2013-2017 $14,000 1 2018-2021 $15,000 1 2022 $16,000 1 2023 $17,000 1 2024 $18,000 1 2025 $19,000 1 APPENDIX A INCOME RESOURCE CHARTS Division of Social Services Medical Assistance Manual 25 July MTL 06/25 MAGI INCOME CHART

MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MAGI MODIFIED ADJUSTED GROSS INCOME (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 (NCU), 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. Medical Assistance for the Aged, Blind and Disabled (MAABD) groups - cover aged, blind, and disabled individuals using non-MAGI and Supplemental Security Income (SSI) budgeting methodologies. These groups can have a resource test for some programs. Individuals requesting medical assistance shall be evaluated under all potential medical groups including NCU 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 five (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 shall 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 the Social Security Administration (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 the Medical Assistance Manual (MAM) section D-540 Conversions for more information. B-100 MAGI MEDICAL CATEGORIES Division of Welfare and Supportive Services Medical Assistance Manual 25 Apr MTL 05/25 OVERVIEW