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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2024 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.300 12

C. Financial Eligibility Modified Adjusted Gross Income (MAGI) methodology is applicable to this covered group. The MAGI policies and procedures are contained in Chapter M04. 1. Assistance Unit The assistance unit for this covered group is the MAGI household. 2. Resources There is no resource test.

3. Income MAGI income rules are applicable to this covered group. The income limits for the Child Under Age 19 covered group are contained in M04, Appendix 2.

4. Income Changes Any changes in a Medicaid-eligible child’s income that occur after his eligibility has been established affect eligibility. Recalculate income and compare to the income limits.

5. Income Exceeds Limit A child under age 19 whose income exceeds the income limit for this covered group may be eligible for FAMIS. The income limit for FAMIS is 200% FPL plus a 5% FPL income disregard. See Chapters M21 and M04 to determine FAMIS eligibility. If countable income exceeds the limit for Medicaid and FAMIS and the child is under age 18, the opportunity for a Medically Needy (MN) evaluation must be offered (see M0330.803). Ineligible children, other than incarcerated children, must be referred to the Health Insurance Marketplace for evaluation for the APTC.

D. Entitlement Eligible children are entitled to full Medicaid coverage beginning the first day of the child’s application month if all eligibility requirements are met in that month, but no earlier than the date of the child’s birth. Retroactive coverage is applicable to this covered group. Children under 19 receive 12 months of continuous eligibility unless they reach age 19; are no longer Virginia residents; the child or child’s representative requests eligibility be closed; the agency determines that eligibility was incorrectly approved because of agency error or fraud, abuse, or perjury attributed to the child or the child's representative; or the child is deceased.

Eligible children are entitled to all Medicaid covered services as described in chapter M18.