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Manual Title Virginia Medical Assistance Eligibility Chapter M04 Page Revision Date October 2018 Subchapter Subject M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) Page ending with M0450.300 Page 27

Richards’s eligibility determination: Potential covered groups: Child < Age 19 FAMIS Monthly Income limits: Child < 19 - 143% FPL for a HH of 3 = $2,477 FAMIS 200% FPL for HH of 3 = $3,464 5% FPL Disregard for HH of 3 = $86

Richard’s gross HH income of $1,425 (his father’s and sibling’s earnings) is less than the FAMIS 200% income limit of $3,464. And as the HH income does not exceed the Medicaid Child < Age 19 income of $2,477, the 5% disregard is not needed. Richard is eligible for full-coverage MA.

M0450.300 INCOME EXAMPLES – NON TAX FILER HOUSEHOLDS

A. Example #1 Robb lives in the City of Norfolk (Group II) with his sons, and does not file taxes. He receives of $2,500 per month disability income. His children receive monthly interest on trust accounts their grandparent’s setup. Mike is 16 years old and receives $500 per month while Ike is 13 years old and receives $400 per month. Non Tax Filer Single Parent, Two Children

(Using Jan. 18, 2018 figures) The MAGI households are:

Person # - Household Composition Reason Robb 3 – Robb, Mike & Ike Non tax filer & his 2 children < 19 Mike 3 – Mike, Robb & Ike Non-filer child < 19, his parent & his sibling < 19 Ike 3 – Ike, Robb & Mike Non-filer child < 19, his parent & his sibling < 19