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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 29

Mike’s countable income of $3,314.00 exceeds the Medicaid Child < Age 19 143% FPL income limit for 3, $2,477. Mike is not eligible for Medicaid. His gross HH income of $3,400.00 is then compared to the FAMIS 200% FPL income limit for 3, $3,464. He is eligible for FAMIS because his gross HH income is less than the FAMIS income limit for the household size. Ike’s income 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 Ike’s countable income of $3,314.00 exceeds the Medicaid Child < Age 19 143% FPL income limit for 3, $2,477. Mike is not eligible for Medicaid.

As his gross monthly income exceeded the Medicaid Child < Age 19 143% income limit of $2,477, he is entitled to the 5% disregard. Ike’s income eligibility is determined as follows: $3,400.00 gross household income - 86.00 5% FPL disregard $3,314.00 countable income

As his countable income exceeds the income limit of $2,477, he is ineligible for Medicaid child <19, and move to the next step.

His gross HH income of $3,400.00 is compared to the FAMIS 200% FPL income limit for 3 of $3,464. He is eligible for FAMIS because his gross HH income is less than the FAMIS income limit for the household size of 3.

This example also illustrates as even though Mike and Ike had different trust account income, it made no difference in the results, and both eligible for FAMIS coverage.