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Manual Title Virginia Medical Assistance Eligibility Chapter M04 Page Revision Date January 2025 Subchapter Subject M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) Page ending with Appendix 1 Page 2

GAP-FILLING RULE EVALUATION 100% FPL INCOME LIMITS EFFECTIVE 1/15/25 Household size Annual (Use for Gap-filling Evaluation) Monthly 1 $15,650 $1,305 2 21,150 1,763 3 26,650 2,221 4 32,150 2,680 5 37,650 3,138 6 43,150 3,596 7 48,650 4,055 8 54,150 4,513 Each additional, add 5,500 459