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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M04 October 2018 Subchapter Subject Page ending with Page M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) M0450.200 25 Samantha’s eligibility determination: Potential covered groups: LIFC MAGI Adult Plan First. Monthly Income limits: LIFC, Group I for HH of 3 = $484 MAGI Adult income limit for HH of 3=$2,391 Plan First for HH of 3 = $3,464 5% FPL Disregard for HH of 3 = $86 HH monthly income: $4,500 Mary’s earnings (Samantha’s income is not counted in this HH). As $4,500 exceeds the LIFC limit for 3 ($484) she is entitled to the 5% FPL disregard. Her income eligibility is determined as follows: $4,500.00 gross household income - 86.00 5% FPL Disregard for HH of 3 $4,414.00 countable income Samantha’s countable income of $4,414 still exceeds the LIFC income limit for 3 of $484 so she is not eligible for LIFC (full-coverage) MA. Her countable income of $4,414 is compared to the MAGI Adult income limit for household of 3 which is $2,391. Mary’s income exceeds the MAGI Adult limit, therefore, making her ineligible for full coverage MA The gross HH income of $4,500.00 is compared to the Plan First 200% FPL income limit for 3 which is $3,464, and as Samantha exceeds this amount, the 5% FPL Disregard ($86) can be deducted. The countable income of $4,414 is greater than the Plan First income limit of $3,464. Samantha is not eligible for Plan First, and is referred to the HIM. An alternate method, which accomplishes the same results, is to compare the Plan First 205% FPL (200% FPL + 5% FPL Disregard) for a HH of 3 which is $3,551. As the countable income amount of $4,500 is greater the income limit of $3,551, Samantha is not eligible for Plan First, and is referred to the HIM. Joy’s eligibility determination HH gross monthly income: $300 Samantha’s earnings (Mary’s income is not counted in this HH). Potential covered group: Child < Age 19 The HH income is $300 which is less than the Medicaid Child < Age 19 limit for 2 ($1,936). Joy is eligible for Medicaid in the Child < Age 19 covered group. The 5% disregard is not necessary since the gross household income is within the Medicaid Child < Age 19 income limit.