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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M04 July 2025 Subchapter Subject Page ending with Page M04 MODIFIED ADJUSTED GROSS INCOME (MAGI) M0420.100 4

• Individuals eligible in the following covered groups:  LIFC (parents and caretaker-relatives)  Pregnant Individuals  Adoption Assistance and Foster Care Children  Former Foster Care Children Under Age 26  BCCPTA

• Supplemental Security Income (SSI) recipients and protected individuals. 7. Psychiatric Residential Treatment Facilities (PRTFs) Children residing in a PRTF (formerly called a Level C PRTF) are not temporarily absent from home. They are indefinitely absent from home and are not living with their parents or siblings for Medicaid purposes, if their stay in the facility has been 30 calendar days or longer. Long-term Services and Supports rules do not apply. See M0520.100 B.4. M0420.100 Definitions

A. Introduction The definitions below are used in this chapter. Some of the definitions are also in subchapter M0310. Some of the definitions are from the IRC. B. Definitions 1. Advance Premium Tax Credit (APTC) is a tax credit that an individual or family with taxable income of at least 100% FPL but no more than 400% FPL can take in advance to lower their monthly health insurance premium. Eligibility for the APTC is determined by the federal HIM using MAGI rules for tax-filer households. Projected annual household income, rather than monthly income, is evaluated. 2. Attested Income means the agency must review income information attested by the applicant and utilize online systems information verifications that are available to the agency without requiring verifications from the individual or family. The agency has ready access to Supplemental Nutrition Assistance Program (SNAP) and TANF records, some wage and payment information, information from SSA through SVES or SOLQ-I and other verified income in the eligibility record or system. Verification of income from available sources, including the VEC, may be used if it is dated within the previous 6 months. 3. Caretaker Relative means a non-parent relative of a “dependent” child by blood, adoption, or marriage with whom the child lives, who assumes primary responsibility for the child’s care. When a parent is in the home, no adult relative other than a stepparent can be eligible for Medicaid in the LIFC covered group. 4. Child means a natural, biological, adopted, or stepchild. 5. Childless Adult a childless adult is someone who does not meet the definition of an LIFC parent or caretaker-relative. 6. Coverage Gap and Gap-filling Rule occurs when the difference in eligibility rules between the APTC and Medicaid/FAMIS creates a situation in which an applicant may appear to be financially ineligible for both the APTC (household income is too low) and Medicaid or FAMIS (household income is too high). The gap-filling rule is applied in such cases to help mitigate the coverage gap.