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Manual Title Virginia Medical Assistance Eligibility Chapter M04 Page Revision Date January 2026 Subchapter Subject M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) Page ending with M0450.300 Page 31

Jane’s eligibility determination:

Potential covered groups: LIFC MAGI Adult Medicaid Pregnant Women Monthly Income limits: LIFC, Group I for HH of 3 = $381 Pregnant Women 143% FPL for a HH of 3 = $2,477 MAGI Adult income limit for HH of 3=$2,391 5% FPL for 3 = $86 HH monthly income = $300 Jane’s income.

Jane is over age 19, not a child and not counted as a dependent for anyone else. Jane’s earnings must be counted even though she is not required to file taxes. As her mother (Sally) is not in Jane’s tax filing HH, Sally’s income is not counted when determining Jane’s eligibility. The HH would consist of Jane, her unborn child and her daughter Dee.

$300 is less than the LIFC limit for 3 ($381) so the 5% disregard is not applied (it is not necessary). Jane is eligible for Medicaid in the LIFC covered group. If Jane had been over income for the LIFC covered group, the step to apply the 5% disregard would have been used. If she was found over the LIFC income limit, a review as a Medicaid Pregnant Woman 143% income limit would have been used.

Dee’s eligibility determination: Potential covered groups: Child < Age 19 FAMIS Monthly Income limits: Child < Age 19 143% FPL for a HH of 2 = $1,962 FAMIS, 200% FPL for HH of 2 = $2,585 5% FPL for 2 = $65 HH monthly income: $300 (Jane’s gross earnings)

As HH income $300 is less than the Medicaid Child < Age 19 143% FPL income limit for 2 ($1,962), Dee is eligible for Medicaid. The 5% disregard is not necessary since she qualified in this aid category.