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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 October 2018 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.250 10b

D. Resources Although no resource test is applicable for MAGI Adults coverage, the worker must evaluate certain resources for any individuals seeking Medicaid payment for LTSS. These include asset transfers, trusts, annuities, and the home equity limit. See M1410.050 E. Financial Eligibility MAGI methodology is applicable to the MAGI Adults covered group. The policies and procedures contained in Chapters M04 are used to determine eligibility for these individuals. 1. Basis For Eligibility The basis for financial eligibility is the individual’s MAGI household. See M0430.100.

2. Income The income limits, policies and procedures used to determine eligibility in this covered group are contained in Chapter M04.

3. Income Exceeds Limit If the individual’s income exceeds the MAGI Adults income limit, the individual must be evaluated for eligibility in any other full benefit Medicaid group. If not eligible in a full benefit category, the individual must be evaluated for any limited benefit coverage for which they may be eligible.

4. Spenddown Spenddown does not apply to any MAGI Adults covered group.

F. Referral to Health Insurance Marketplace If the individual is not eligible for any full benefit Medicaid coverage group due to income over the applicable limit, the individual must be referred to the HIM for evaluation for the APTC. G. Entitlement Entitlement in Medicaid as a MAGI Adult begins the first day of the month in which the Medicaid application is filed, if all eligibility factors are met in that month. Retroactive entitlement, up to three months prior to application, is applicable if all Medicaid eligibility criteria were met during the retroactive period; however, retroactive coverage in the MAGI Adults group is not available for any month prior to January 1, 2019. H. Enrollment The Medicaid aid categories for MAGI Adults are:

AC Meaning

100 Parent/caretaker relative; income above the LIFC limit and below 100% FPL (no 5% disregard)

101 Parent/caretaker relative; income greater than 100% FPL, but less than or equal to 138% FPL (133% + 5% disregard)

102 Childless adult; income at or below 100% FPL (no disregard)

103 Childless adult; income greater than 100% FPL, but less than or equal to 138% FPL (133% + 5% disregard)

106 Presumptively-eligible MAGI Adult; income at or below 138% FPL (133% + 5% disregard)

108 Incarcerated adult

I. Long Term Services and Supports Once medical assessment and financial evaluation are approved, a MAGI Adult may receive facility based or home and community based LTSS. Patient pay does not apply to MAGI Adults.