Page 14

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M04 July 2024 Subchapter Subject Page ending with Page M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) M0430.200 8

• For non-filers, a “child” is defined as under age 19. 4. Married Couple In the case of a married couple living together, the spouse is always included in the household of the other spouse, regardless of their tax filing status. This includes a tax dependent living with both a tax filer parent AND the dependent’s spouse. The tax dependent’s household includes his spouse, the tax filer, any other parent in the home, and any siblings in the home who are also claimed by the same tax filer. 5. Tax Filer is Under Age 19 If the tax filer is under age 19, lives in the home with the parent(s) AND is not expected to be claimed as a dependent by anyone, the parent(s) are included in the child’s household. 6. Gap-filling Rule States are required to use household income, as calculated by the federal HIM for the APTC eligibility determination, to determine eligibility for Medicaid or FAMIS if all of the following conditions apply: a. The individual is in a tax filer household (including those who meet a tax dependent household exception in M0430.100 B.2). APTC methodology does not apply to non-filer households. b. Current monthly household income, using Medicaid/FAMIS MAGI-based methods is over the applicable monthly income limit (including the 5% FPL disregard) for the individual’s covered group. c. The total income already received plus projected income for the calendar year in which eligibility is being determined, using MAGI methods applied by the HIM for the purposes of APTC eligibility, is below 100% FPL (i.e. the lower income threshold for APTC eligibility). See M04, Appendix 1. This requirement is referred to the gap-filling rule. See M0450.400 for gap-filling rule evaluation procedures and examples.

M0430.200 TAX FILER HOUSEHOLD EXAMPLES

A. Married Parents and Their Tax Dependent Children Sam and Sally are a married couple. They file taxes jointly and claim their two children Susie and Sarah as tax dependents. All of them applied for MA. The MAGI household is the same as their tax household because the tax filers are a married couple filing jointly and claiming their dependent children. No additional individuals live in the home. Ask the following questions for each tax dependent to determine if exceptions exist: • Is Susie the tax dependent of someone other than a spouse or a biological, adopted, or stepparent? No, also applies to Sarah • Is Susie a child living with both parents, but the parents do not expect to file a joint tax return? No, also applies to Sarah • Is Susie a child who expects to be claimed by a non-custodial parent? No, also applies to Sarah