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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M04 January 2026 Subchapter Subject Page ending with Page M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) M0410.100 2

• has no resource test (Exception: MAGI Adults requesting coverage of Long-Term Care services are subject to certain asset/resource requirements) 2. MAGI Rules • MAGI has an income disregard equal to 5% of the federal poverty level (FPL) for the Medicaid or FAMIS individual’s household size. The disregard is only given if the individual is not eligible for coverage due to excess income. It is applicable to individuals in both full-benefit and limited-benefit covered groups. • If the individual meets multiple Medicaid covered groups (and/or FAMIS) his gross income is compared first to the income limit of the group with the highest income limit under which the individual could be eligible. • If the income exceeds the limit, the 5% FPL disregard can be allowed, and the income again is compared to the income limit. • When considering tax dependents in the tax filer’s household, the tax dependent may not necessarily live in the tax filer’s home. • Under MAGI counting rules, an individual may be counted in more than one household but is only evaluated for eligibility in his household. • Use non-filer rules when the household does not file taxes. • Use non-filer rules when the applicant is claimed as a tax dependent by someone outside the applicant’s household. • Non-filer rules may be used in multi-generational household. 3. Eligibility Based on MAGI MAGI methodology is used for eligibility determinations for insurance affordability programs including Medicaid, FAMIS, the Advance Premium Tax Credit (APTC) and cost sharing reductions through the Health Insurance Marketplace for the following individuals: 4. Eligibility NOT Based on MAGI a. Children under 19 b. Parent/caretaker relatives of children under the age of 18 - Low Income Families With Children (LIFC) c. Pregnant individuals, including LIFC, FAMIS MOMS and FAMIS Prenatal Coverage d. Individuals Under Age 21 e. Adults between the ages of 19 and 64 not eligible or enrolled in Medicare (effective January 1,2019)

f. Individuals in Plan First.

MAGI methodology is NOT used for eligibility determinations for: individuals for whom the eligibility worker is not required to make an income determination: