Effective Date: March 1, 2022

Previous Policy

Income Standard

For adult and child eligibility, an individual’s countable income that is expected to be received during the 12 month certification period must be above 133% and cannot exceed 200% of the Federal Poverty Limit for the household size ( Table VII ).

MAGI-Based Income

The Medicaid agency must use the MAGI methodology to determine countable income and allowable deductions based on tax rules. (See 440 ).

Determining Countable Income

When determining the countable income for UPP, the allowable deductions vary slightly from the MAGI methodology. Use the following criteria to determine the allowable pre-tax deductions for each individual.

Applicants not included in the UPP benefit:

Allow all pretax deductions including any health insurance premium paid by the household for applicants not included on the UPP benefit. This includes the total amount paid for the UPP qualified health insurance and any other allowable pre-tax deductions ( 440-4 ).

If the applicant is determined eligible for Medicaid with or without the deduction open Medicaid.

If the applicant is determined eligible for UPP with the deduction, add the individual to the UPP benefit the first of the month of request or application. (See 1007 for effective date for the premium payment)

If the applicant’s countable income is over the income limit for UPP , the agency will transfer the electronic record to the Federally Facilitated Marketplace (FFM) for that individual.

UPP Recipients:

For UPP recipients do not allow the health insurance premium for the UPP qualified plan . Continue to allow other pre-tax deductions such as Health Savings Account contributions, pre-tax retirement contributions, pre-tax health premium payments for separate dental, vision or any other health insurance plans ( 440-4 ).

If the UPP member is determined eligible for Medicaid without the deduction, remove the Medicaid eligible individual/s from UPP and open Medicaid.

If the countable income for the UPP member is over the income limit for UPP without allowing the deduction, do not act on the change until the next certification period.

Example: Doug is enrolled in his employer’s sponsored insurance and pays $160 per month. His employer only offers health coverage to the employee. His wife Sandi and their 2 children are not enrolled in a health plan but have access to employers sponsored insurance through Sandi’s employer. Sandi and her two children are eligible for UPP as her employers sponsored insurance meets all the UPP criteria. Sandi pays $400 per month for the family plan and is receiving an UPP re-imbursement of $390 per month. When processing the review for UPP, the premium for the employers sponsored insurance that is the UPP qualified plan is not an allowable deduction for Sandi and the two children, but the $160 that Doug pays per month is an allowable deduction as well as any other allowable pretax deduction when determining the countable income.