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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 28

HH income: $2,500.00 Robb’s disability benefit income + 500.00 Mike’s trust income + 400.00 Ike’s trust income $3,400.00 gross household income Robb’s gross HH’s of $3,400 monthly income exceeds the LIFC income limit for 3 of $589 per month, thus entitled to the 5% disregard. His income eligibility is determined as follows: $3,400.00 gross household income - 86.00 5% disregard $3,314.00 countable income As his countable income exceeds the LIFC income limit of $589, he is ineligible for full coverage MA. His gross income of $3,400.00 is compared to the MAGI Adults income limit for household of 3 which is $2,391. After applying the 5% disregard, Robbs’s income exceeds the MAGI Adults limit. Robb is ineligible for full coverage MA. His gross HH income of $3,400.00 is then compared to the Plan First 200% FPL income limit for 3 of $3,464. As the income is less than the Plan First income limit, he is eligible for Plan First. Robb is also referred to the HIM. Mike’s eligibility determination: Potential covered groups: Child < Age 19 FAMIS Monthly Income limits: Child < Age 19, 143% FPL for a HH of 3 = $2,477 FAMIS, 200% FPL for HH of 3 = $3,464 5% FPL for 3 = $86 HH income: $2,500.00 Robb’s disability benefit income + 500.00 Mike’s trust income + 400.00 Ike’s trust income $3,400.00 gross household income Mike’s gross HH’s $3,400 monthly income exceeds the Medicaid Child < Age 19 143% FPL income limit for 3, $2,477, so he is entitled to the 5% disregard. Mike’s income eligibility is determined as follows: $3,400.00 gross household income - 86.00 5% FPL disregard $3,314.00 countable income