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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M04 January 2024 Subchapter Subject Page ending with Page M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) M0410.100 1 M0410.000 MODIFIED ADJUSTED GROSS INCOME (MAGI) M0410.100 MAGI GENERAL INFORMATION A. Introduction Effective October 1, 2013, determinations of eligibility for most families and children (F&C) Medicaid covered groups and the Family Access to Medical Insurance Security Plan (FAMIS) were completed using the Modified Adjusted Gross Income (MAGI) methodology. Effective January 1, 2019, determination of eligibility for adults age 19-64 without Medicare were evaluated using MAGI income methodology. These individuals are referred to as MAGI Adults. MAGI methodology is also used to determine eligibility for Premium Tax Credits through Virginia’s Insurance Marketplace. Medicaid, FAMIS and Virginia’s Insurance Marketplace (VIM) are called insurance affordability programs. Medicaid and FAMIS are collectively referred to as medical assistance (MA) programs. For all case actions effective October 26, 2019, verification of earned and unearned income were evaluated using attested income and reasonable compatibility rules. Whenever possible, income reported on the application are verified through electronic data sources. The goal of using MAGI methodology for all insurance affordability programs is to align financial eligibility rules, provide a seamless and coordinated system of eligibility and enrollment, and maintain the eligibility of low-income populations, especially children. A federal mandate requires that as of January 1, 2024, all children under 19 receive 12 months of continuous eligibility unless they reach age 19; are no longer Virginia residents; the child or child’s representative requests eligibility be closed; the agency determines that eligibility was incorrectly approved because of agency error or fraud, abuse, or perjury attributed to the child or the child's representative; or the child is deceased. B. Legal Base The Patient Protection and Affordable Care Act of 2010 (Pub. L. No. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111- 152) (collectively referred to as the Affordable Care Act [ACA]) is the legal base for the changes required to be made in the Medicaid and CHIP (FAMIS) eligibility determinations. The 2018 Appropriations Act provided funding for New Health Coverage Options for Virginia Adults. Effective January 1, 2019, determination of eligibility for adults between the ages of 19-64 without Medicare will be evaluated using MAGI income methodology. Adults eligible under the expansion of coverage will be referred to as Modified Adjusted Gross Income (MAGI) Adults. Individuals in the MAGI Adults covered group are not subject to a resource test unless the individual requests Medicaid payment for LTC/LTSS. The resource and home equity requirements for MAGI Adults are contained in M1460. MAGI and household income are defined in section 36B(d)(2)(A) and (B) of the Internal Revenue Service Code (IRC). The MAGI-based methodology under the Medicaid statute includes certain unique income counting and household (HH) composition rules reflected in the Centers for Medicare and Medicaid Services (CMS) regulations at 42 CFR 435.603 and discussed in section III.B. of the preamble to the eligibility final rule published in the Federal Register on March 23, 2012. C. Policy Principles 1. What is MAGI? MAGI is a methodology for how income is counted and how household composition and family size are determined and is based on federal tax rules for determining adjusted gross income (with some modification), and has no resource test (Exception: MAGI Adults requesting coverage of Long Term Care services are subject to certain asset/resource requirements).