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227 (07/2026) Chapter 2:Eligibility • Section 5: Financial eligibility HSD Most HSD medical programs follow IRS rules for counting income and use Modified Adjusted Gross Income (MAGI) to determine program eligibility and benefit level of applicants. With some exceptions, MAGI income includes federally taxable income already received and reasonably expected to be received. Each person for whom benefits are requesting for will have the countable income from their EDG compared to the income standards chart.

HSD medical programs that use MAGI have both a monthly and annual income test. The monthly income uses MAGI-based methodology and prospective budgeting. The annual income test uses MAGI methodology and is performed when someone requesting benefits is not eligible using monthly income. The OHP Bridge-Basic Health Program (BHP) uses MAGI methodology for financial eligibility evaluation and the OHP Bridge-Basic Medicaid program (PME) uses MAGI-based methodology for financial eligibility. A two-step process is used to determine whether an individual meets the income requirements: • For BHP: In step 1, the monthly income is first compared to 138% FPL. If it is over, then step 2 is performed, where the system will use the information from the annual income screen and if their expected annual income is between 133% and - 200% FPL, the individual meets the financial requirement for BHP. • For PME: If monthly income is between 138% and 205% FPL the individual meets the

The difference between the monthly and annual income test is outlined in the paragraph below where the eligibility rules for the 100% annual income test are stated.

For the annual income test, income received for the calendar year is compared to the 100 percent FPL standard. If the annual income is below the 100 percent FPL, it is converted to a monthly amount and applied to the budget month by ONE. The following eligibility rules apply to the 100% annual income test: • The annual income test can only be used for tax filers or tax dependents. • The annual income test cannot be applied for individuals who are married filing separately. • The annual income test counts taxable income excluded for MAGI-based determinations (what is used for the monthly income test). These include foreign earned interest, tax-exempt interest, Tribal, scholarship income and, under some conditions, Social Security Disability Insurance (SSDI) and Social Security benefits (SSB) income. • Unborn children do not count toward the family size group for annual income. Note: The annual income test, as described above, does not apply to the BHP or the PME. The BHP does utilize MAGI methodology when determining financial eligibility meaning unborn children do not count toward the family size group when determining EDG size for annual income and taxable income excluded for MAGI-based determinations is included. But, if annual income is above 200% FPL for the BHP or if monthly income is above 205% FPL for the PME, the financial requirements are not met. In ONE, the system runs a data fix at the beginning of October each year, to where annual income amounts for the current year are copied for the next calendar year. Income of the following individuals is excluded when they are not expected to be required to file a tax return for the tax year in which eligibility is being determined. This is true whether the child or tax dependent actually files a tax return: