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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M04 July 2019 Subchapter Subject Page ending with Page M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) M0450.400 36
G. Example – Gap-Filling Evaluation— Childless Adult (Using 2019 Income Limits) Since the child’s countable income is under the lower financial threshold for the APTC and he has excess income using non-filer rules, the child’s eligibility must be evaluated using gap-filling rules. Lee, age 27, is a tax-filer and applies for Medicaid on June 1. He is attending graduate school and works part-time as a teaching assistant. His income for June is $1,625. The 5% FPL disregard amount of $53 is deducted ($1,625 - $53 =$1,572) and income exceeds the limit for the MAGI Adults covered group for a HH of 1 ($1,436). Lee is not eligible for Medicaid using MAGI methodology.
Lee calls the worker when he receives the denial notice and tells the worker that his income is higher in the summer and less during the remainder of the year and requests to be evaluated for retroactive coverage for March- May. A potential gap-filling situation exists, so the worker requests verification of Lee’s income from January through May. He provides his paystubs for January ($710), February ($720), March ($697), April ($752), and May ($715). His total year to date income is $3,594. Lee also provides a letter from his employer that states his teaching income for September thru December will be a guaranteed amount of $715 per month. The worker uses a projected amount for September – December of $715 per month, which totals $2,860. January - May $3,594 June- August $4,875 September- December (projected) $2,860 Total Projected Annual Income $11,329 The total annual projected income of $11,329 is under the 100% annual FPL of $12,490 for household size of 1. The projected annual amount of $11,329 is compared to the 133% annual FPL limit for household size of 1 ($16,612). Lee is eligible for retroactive Medicaid coverage and ongoing coverage as a MAGI Adult.