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B. Non-financial Requirements

The individual must meet a MAGI covered group (Children under 19, LIFC, Pregnant Individuals, Individuals Under Age 21, Adults age 19-64, Plan First).and all non-financial eligibility criteria for that covered group. C. Household Income Calculation Under the gap-filling rule, the individual’s household income must be calculated according to the MAGI rules used for APTC purposes and compared to the APTC 100% FPL annual income limit for the household size in M04 listed in, Appendix 1. If the annual income at or below the APTC 100% FPL amount, the income is then compared to the Medicaid annual income limits for the individual’s covered group or to the FAMIS or FAMIS MOMS income limits to determine the individual’s eligibility. Only tax-filer rules are used for determining household composition for gap- filling determinations. Neither the tax dependent exceptions used for Medicaid/FAMIS MAGI-specific household composition nor non-filer rules are applicable. For example, if a child lives with both parents, and the parents are unmarried, the child is in the tax-filer household of the parent who claims the child as a tax dependent. Financial eligibility is based on income already received and projected income for the calendar year in which benefits are sought. If the local agency knows the determination of annual income made by the HIM, it may use that information for the purposes of applying the gap-filling rule. Otherwise, the worker must obtain income information from the individual or authorized representative. 1. Verification of Income Income reported as received for the calendar year in which benefits are sought as well as current monthly income must be verified. If the information provided is reasonably compatible with information obtained by the worker from electronic sources such as the VEC, or documentation is available from other social services program, such as TANF or SNAP, and the systems information is dated within the past 6 months, the agency must determine eligibility based upon the information available. If there is a discrepancy between what is stated on the application and the information obtained from online systems/agency knowledge, contact the enrollee to obtain clarification of reported income. 2. Countable Income Income that is listed in M0440.100 B as countable for the Medicaid/FAMIS MAGI evaluation is also countable for the gap-filling evaluation. Additionally, the following income is counted for the gap-filling evaluation only if it is countable for taxes: • Payments made to American Indian/Alaska Natives as described in M0440.100 B.5. • Scholarships/Awards and fellowship income, regardless of its intended use • Lump sum payments received in the calendar year for which benefits are sought are included in the annual income calculation only 3. Income Evaluation If the annual income as determined by the HIM is not known, the eligibility worker must calculate the annual income. Do not convert this income

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M04 July 2025 Subchapter Subject Page ending with Page M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) M0450.400 33