1. What does “MAGI-Based Eligibility” mean?
“MAGI” stands for “Modified Adjusted Gross Income.” MAGI-Based Eligibility methodology is used to calculate a person’s household size and income.
2. When did MAGI rules go into effect?
The new MAGI rules for determining Medicaid eligibility became effective on January 1, 2014.
3. Will MAGI rules apply to everyone seeking Medicaid coverage?
MAGI-Based Eligibility applies to individuals who are considered Covered Families and Children (CFC) Medicaid categories including families, children up to age 19, pregnant women and adults 19 – 64 who are below 138% Federal Poverty Level (FPL).
MAGI rules also apply to time-limited coverage for individuals who were enrolled in Medicaid’s parent category and lost eligibility due to increased earnings or spousal support.
4. What are the categories of Medicaid that are not impacted by MAGI rules?
The following people or groups will NOT use the new MAGI rules to determine eligibility:
- People not subject to an income decision by Medicaid including children in foster care and individuals found eligible under the Breast and Cervical Cancer Project
- Medicare-age adults (65 or older) seeking Medicaid due to medical needs caused by age
- Qualified Medicare Beneficiaries
- Individuals certified as blind or disabled by the Social Security Administration (excluding individuals who are seeking coverage as a parent)
- People seeking Long-Term Care
*This list is a general guideline; there are some situations where an individual can be considered in more than one Medicaid program category. This includes an applicant being eligible for both a MAGI and Non-MAGI program category. If you think you or the applicant you are working with may fall into more than one category, please visit your local CDJFS for detailed information.
5. Why is Ohio using MAGI rules to determine who is counted in Medicaid households and what income is being counted?
The introduction of MAGI rules is a federal requirement introduced to all states. MAGI rules make calculating household size and income consistent across the United States.
The new MAGI standards are based on federal income tax rules and uses a tax filer’s family size and income to determine eligibility. If you do not file taxes, your family size will be based on the number and age of the immediate family members who live with you. In general, only income included for federal tax purposes is counted. Income that is not included when filing federal taxes is most likely not counted for MAGI calculations.
- Child support is not considered income when filing federal taxes. Child support is not counted as income when determining Medicaid eligibility.
- Spousal support is considered income when filing federal taxes. Spousal support is counted as income when determining Medicaid eligibility.
For additional help please visit your local CDJFS or call the Medicaid Hotline at (800) 324-8680.
6. Right now, I have a Medicaid Spenddown. Do I now qualify for full Medicaid benefits due to recent eligibility changes?
If you have a spenddown, you may qualify for Medicaid through recent eligibility changes. To determine if you are eligible under a MAGI Medicaid category, you must re-apply and submit a new Medicaid application and meet all of the following criteria:
- Income must be at or below 133% federal poverty level (FPL);
- Must be between the ages of 19 – 64;
- Must not be eligible under another category of Medicaid;
- Cannot be a Medicare beneficiary. However, you may be included if you are determined disabled by SSA and currently in the two year waiting period for Medicare
- Parents residing with minor children cannot qualify UNLESS the child has creditable coverage (through Medicaid or privately).