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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 October 2019 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.250 10a

M0330.250 MAGI ADULTS (EFFECTIVE JANUARY 1, 2019)

A. Policy The Virginia 2018 Appropriations Act mandated that effective January 1, 2019, the State Plan for Medical Assistance be amended to add a new covered group for adults between the ages of 19 – 64. This mandate is titled “New Health Coverage Options for Virginia Adults” and the new covered group will be known as MAGI (Modified Adjusted Gross Income) Adults. This new group may be designated in various reports, documentation, or publications of other agencies as New Enrolled Adults, Newly Enrolled Adults, or Medicaid Expansion Adults. The MAGI Adults Group includes: • MAGI Parent/Caretaker Relatives (AC 100, AC 101) who meet Medicaid requirements within a MAGI Adult group and must be responsible for a dependent child under age 18 (or less than age 19, still in school and expected to graduate by his 19th birthday);

• MAGI Childless Adults (AC 102, AC 103) who meet Medicaid requirements within a MAGI Adults group and are not responsible for a dependent child or claim such a child on his tax return;

• MAGI Presumptive Eligible Adults (AC 106) who meet Medicaid requirements within a MAGI Adults group and have had a determination made by an authorized PE Hospital; and

• MAGI Incarcerated Adults (AC 108) who would otherwise be eligible for Medicaid as a MAGI Adult except for being incarcerated in a Department of Corrections (DOC) facility or a local / regional jail. Note: All HPE applications are processed by hospitals and enrolled at Cover Virginia. See M0120.500.D - Hospital Presumptive Eligibility. B. Procedure Eligible individuals in the MAGI Adults group must: • be an individual between the ages of 19 and 64; • have income at or below 138% FPL (133% FPL + 5% FPL disregard); • not be entitled to or enrolled in Medicare Part A or B; • not be eligible in a Medicaid mandatory covered group or the BCCPTA covered group. • meet any other criteria as outlined in the particular aid categories. A person in the MAGI Adults covered group may receive long term services and supports (LTSS) in either a facility or home and community based services (waiver) setting. The individual is still required to be assessed and approved for such care. C. Non-Financial Eligibility The individual must meet all the nonfinancial eligibility requirements in chapter M02. If the individual is not a U.S. citizen, he must meet the alien status requirements. These requirements differ depending on the age and pregnancy status of the individual. See subchapter M0220.