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Manual Title Virginia Medical Assistance Eligibility Chapter Page Revision Date M04 July 2024 Subchapter Subject M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) Page ending with Page M0450.400 34 • First, add together income already received for the year. Do not convert the income. • Next, calculate the projected income for the remainder of the year based on the current monthly income, unless the individual’s income is expected to change (e.g. current employment is terminating). • Add income already received to projected income to obtain the annual projected income for the current calendar year. • Compare the annual projected income to the 100% FPL annual income limits for the MAGI household size in M04, Appendix 1. • If the annual income is less than or equal to 100% FPL, compare the annual income to the annual income limit for the individual’s covered group. • For the individual to be eligible for Medicaid as a result of applying the gap- filling rule, the countable income must be no more than the annual income limit for the individual’s covered group. The 5% income disregard used for the Medicaid MAGI determination does not apply. See M04 Appendices 2- 6 for income limits. 3. Renewals A renewal of eligibility must be completed in January of the following year and annually thereafter. At the time of initial enrollment, change the renewal date to January of the following year. Evaluate the individual’s eligibility using Medicaid/FAMIS MAGI methodology before applying gap-filling methodology. A gap-filling evaluation may not be necessary for future eligibility determinations/renewals since tax dependency status and/or income may have changed. For a pregnant individual determined eligible based on gap-filling methodology, coverage ends the last day of the 12th month after the end of the month in which the pregnancy ends. Complete a renewal 30 days prior to the end of coverage. For a child with 12 months continuous eligibility, coverage ends the last day of the 12th month after the first month of eligibility (not including retroactive coverage). Complete a renewal 30 days prior to the end of coverage. 4. Individual Not Eligible Using Gap-filling Methodology

A. Example Situation – Coverage Gap and Gap-Filling Rule If the individual’s household income is determined to be over the Medicaid and FAMIS income limits after the gap-filling rule evaluation and he meets a MN covered group, he must be offered the opportunity to be placed on a MN spenddown. If the individual does not provide the necessary verifications for the gap-filling evaluation the application should be denied. A 10-year-old child lives with both parents, who are not married, and the child is expected to be claimed as a tax dependent by one parent. His parents apply for the APTC through the Virginia Insurance Marketplace, which uses tax filers income methodology. The child is determined to not be eligible for the APTC because his countable income is below the lower income threshold (it is too low) for APTC eligibility.