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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M04 April 2019 Subchapter Subject Page ending with Page M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) M0450.400 35

E. Example – Gap- Filling Evaluation Unmarried Couple and Child in Common

F. Example – Gap-Filling Evaluation— (Using 2019 Income Limits) Maria and Tony are an unmarried couple who live with their 12-year-old daughter, Anita. Maria and Tony are both employed. Anita is claimed as a tax dependent by Maria, who works part time. Maria applies for Medicaid only for Anita. Because Anita lives with both parents, but the parent’s file taxes separately and only one parent claims her as a tax dependent, Anita meets a tax dependent exemption. Her eligibility must be evaluated using non-filer rules. Because she is under age 19, Anita’s MAGI household consists of Anita and both parents. Both Maria’s and Tony’s income is counted for Anita’s eligibility. Her countable income, including with the 5% FPL disregard, is over the limits for both Medicaid and FAMIS. The eligibility worker notes that a potential gap-filling situation exists. The worker evaluates Anita’s eligibility for Medicaid or FAMIS using the APTC rules. Under the APTC rules, Anita’s household consists of Anita (tax dependent) and Maria (tax filer); Tony is not in Anita’s household because he does not claim Anita on his taxes. Maria’s income from her part time job is under the APTC 100% FPL annual income limit and under the Medicaid annual income limit for a Child Under 19 (143% FPL). Therefore, Anita is eligible for Medicaid under the gap-filling rule. The following tables show the household formation and income used. For the Medicaid/FAMIs evaluation: Person # - MAGI Household Composition Non-filer rules Income to count for Medicaid/FAMIS eligibility Anita 3 – Anita, Maria, Tony Maria, Tony For the gap-filling evaluation Person # - ATPC Household Composition Income to count for Medicaid/FAMIS eligibility Anita 2 – Maria, Anita Maria, and (non-excluded) income from Anita An application was filed on 7/4//18 by Tom (tax-filer) for his two children Tia (age 8) and Tony (age 10). The household size is 3 (Tom, Tia and Tony) Tom was unemployed from January –June and started a new job in July. Tom earns $1750 bi-weekly. Only one pay was received in July ($940.62). The income is calculated as $1,750 x 2.15 =$3,762.50. The 5% FPL disregard amount of $89 is deducted ($3,762.50- 89=$3,673.50) and income exceeds the monthly FPL limits for FAMIS ($3,555). The worker requests income already received during the current tax year and Tom’s employer verifies the following:

January- June $0 July 23 $940.62 August – December (projected) $18,812.50 Total Projected Annual Income $19,753.12 The total annual projected income is of $19,753.12 is under the 100% annual FPL for household size 3 ($21,330). The projected annual amount of $19,753.12 is compared to the 143% annual FPL limit for household size of 3 ($30,502) and both children are eligible for Medicaid.