North Carolina Department of Health and Human Services

North Carolina Medicaid

Division of Health Benefits

FAMILY AND CHILDREN’S MEDICAID MANUAL MA-3306

Modified Adjusted Gross Income (MAGI)

1

REVISED 12/5/18 – CHANGE NO. 06-18

I. INTRODUCTION

This section provides eligibility information in regards to Modified Adjusted Gross Income

(MAGI) policies and procedures.

MAGI methodology is used to determine countable income and household composition

based on tax rules for most Medicaid categories when determining eligibility.

MAGI methodology includes:

A. Taxable income is countable income

B. Non-taxable income is excluded income

C. There is no asset or resource test

D. A 5% income disregard is applied when the applicant/beneficiary’s income exceeds

the highest comprehensive full Medicaid program income limit or NCHC limit

E. Household size is determined by the principles of tax dependency, filer and non-filer

tax rules

II. MAGI MEDICAID CATEGORIES

Determinations of eligibility for most Family Medicaid covered groups, including those

in the Federal Marketplace, use MAGI.

A. Infants and Children under 19

B. Pregnant Women

C. 19 and 20-Year-Olds

D. Parents/ Caretaker Relatives

E. Family Planning Program

F. Former Foster Care Children up to age 26 (MFC)

G. HSF Foster Care

III. HOUSEHOLD COMPOSITION

Household composition determines the income limit and whose income may be used in the

eligibility determination. The household composition is determined separately for each

household member.

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A. Determining Household

The household is determined based on whether the individual is a tax filer, tax dependent

or a non-tax filer.

1. Tax Household

a. If the individual is the tax filer, the MAGI household consists of the

following:

1) Tax filer – an individual who expects to file a tax return for the taxable

year;

2) Spouse living with the tax filer; and

3) All persons whom the tax filer expects to claim as tax dependents.

b. If the individual is a tax dependent, the MAGI household consists of:

1) Tax dependent – an individual expected to be claimed as a dependent

by someone else (whether or not he/she expects to file taxes) for the

taxable year;

2) Tax dependent’ s spouse, if living together; and

3) All member of the household of the tax filer who claims the individual

as a tax dependent.

c. If the individual is a tax dependent and meets one of the following exceptions,

apply the non-filer rules in 2. below:

1) An individual is claimed as a tax dependent by someone other than a

spouse or a natural, adoptive, or stepparent.

2) A child under the age of 19 is living with parents who do not expect to

file a joint tax return. This may include a stepparent.

3) A child under the age of 19 is claimed as a tax dependent by a non-

custodial parent.

2. Non-filer Household

a. If the individual does not expect to file taxes and does not expect to be

claimed as a tax dependent, or is a tax dependent who meets an exception in

1.c above, the MAGI household consists of the individual and, when living in

the home, with:

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1) The individual’s spouse; and

2) The individual’s natural, adoptive, and step children under the age of

19.

b. If the individual is under age 19, the MAGI household is the same as B.1.

above and includes:

1) The individual’s natural, adoptive, and stepparents; and

2) The individual’s natural, adoptive, and step siblings under the age of

19.

3. When determining the family size of a household containing at least one pregnant

woman, each pregnant woman is counted as herself plus one. If there are more than

one fetus, request verification is required.

To add a new household member to an existing case, refer to Job Aid: P7 Adding a New Household

Member Who is Applying to an Existing Integrated Case (CoC).

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B. Constructing the Household

To determine tax filing status for each applicant, apply the MAGI Household

Composition Chart below.

MAGI Household Composition Chart

1 2 3 4 5 6

Will

Applicant/

beneficiary

file Taxes?

Yes

Will applicant/

beneficiary be

a tax

dependent for

anyone else?

No

Will

Applicant/

beneficiary

file Taxes?

No

Will applicant/

beneficiary be

a tax

dependent for

anyone else?

Yes

Does the

Applicant/

beneficiary

meet any of

the

exceptions*?

No

Will

Applicant/

beneficiary

file Taxes?

Yes

Will applicant/

beneficiary be

a tax

dependent for

anyone else?

Yes

Does the

Applicant/

beneficiary

meet any of

the

exceptions*?

No

Will

Applicant/

beneficiary

file Taxes?

No

Will applicant/

beneficiary be

a tax

dependent for

anyone else?

No

Will

Applicant/

beneficiary

file Taxes?

No

Will applicant/

beneficiary be

a tax

dependent for

anyone else?

Yes

Does the

Applicant/

beneficiary

meet any of

the

exceptions*?

Yes

Will Applicant/

beneficiary file

Taxes?

Yes

Will applicant/

beneficiary be a

tax dependent

for anyone else?

Yes

Does the

Applicant/

beneficiary

meet any of the

exceptions*?

Yes

Tax HH: HH

is applicant,

co-filer spouse

and

individual’s

tax

dependents.

Include live in

spouse if not

included in tax

HH.

Tax HH: HH is tax filer’s

household claiming individual

as a dependent. Include

individual’s live-in spouse if not

included in tax HH.

Non-Filer HH: HH is applicant/beneficiary,

spouse in the home, and their children in home

under age 19.

If applicant/beneficiary is under age 19: Also

includes: live-in parent(s) and live-in siblings

under age 19.

*Exceptions: Is the individual:

• A tax dependent of someone other than

spouse or parent?

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• Under age 19 and living with both parents

who will not file jointly?

• Under age 19 and will be claimed by a non-

custodial parent?

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C. Construct the MAGI household for each individual:

Annie’s Household

Annie (35), Annie’s son Jacob (10) and Annie’s daughter Miley (7) are in the

household. Annie does not expect to file taxes or be claimed as a tax dependent.

1. Annie’s household

Does Annie expect to file taxes? No.

Does Annie expect to be claimed as a tax dependent? No

Annie’s Household is established using the non-filer rules: Annie, Jacob, and

Miley

2. Jacob’s household

Does Jacob expect to file taxes? No.

Does Jacob expect to be claimed as a tax dependent? No

Jacob’s household: Jacob, Annie and Miley (non-filer rules)

3. Miley’s household

Does Miley expect to file taxes? No

Does Miley expect to be claimed as a tax dependent? No

Miley’s household: Miley, Annie and Jacob (non-filer)

Household Determination

Appli

cant MAGI Household Annie Jacob Miley Family Size

Annie x x x 3

Jacob x x x 3

Miley x x x 3

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Mary’s household

Mary (51), Mary’s son Bill (22), Mary’s Nephew Ned (10) and Mary’s niece

Nancy (10) are in the household. Mary claims all as tax dependents.

1. Mary’s household

Does Mary expect to file taxes? Yes

Does Mary expect to be claimed as a tax dependent? No

Mary’s Household is her tax household: Mary, Bill, Ned and Nancy

2. Bill’s household

Does Bill expect to file taxes? No

Does Bill expect to be claimed as a tax dependent? Yes

Does Bill meet any of the tax dependent exceptions? No

Bill is over the age limit and not eligible for coverage unless he wants to

apply for eligibility on basis of disability (non-MAGI) or for Family

Planning Program (FPP).

Bill’s household for FPP: Mary, Bill, Ned and Nancy (the tax household

of the filer who claims him as a dependent)

3. Ned’s household

Does Ned expect to file taxes? No

Does Ned expect to be claimed as a tax dependent? Yes

Does Ned meet any of the tax dependent exceptions? Yes

Ned expects to be claimed by someone other than a spouse or a biological,

adopted, or stepparent. The household consists of himself and his sibling.

Non-filer rules apply.

Ned’s Household: Ned and Nancy

4. Nancy’s household

Does Nancy expect to file taxes? No

Does Nancy expect to be claimed as a tax dependent? Yes

Does Nancy meet any of the tax dependent exceptions? Yes

Nancy expects to be claimed by someone other than a spouse or a biological,

adopted, or stepparent. The household consists of herself and her sibling. Non-

filer rules apply.

Nancy’s Household: Nancy and Ned

.

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Household determination

Appli

cant

MAGI

Household

Mary Bill Ned Nancy Family Size

Mary x x x x 4

Bill x x x x 4

Ned x x 2

Nancy x x 2

Carol’s Household

Carol (49), Carol’s daughter Marcia (17), Marcia’s daughter, Lily (2), are in the

household. Carol claims all as tax dependents.

1. Carol’s household

Does Carol expect to file taxes? Yes

Does Carol expect to be claimed as a tax dependent? No

Carol’s Household is her tax household: Carol, Marcia, and Lily

2. Marcia’s household

Does Marcia expect to file taxes? No

Does Marcia expect to be claimed as a tax dependent? Yes

Does Marcia meet any of the tax dependent exceptions? No

Marcia’s Household is the tax household of the person who claims her as

a dependent: Marcia, Carol, and Lily

3. Lily’s household

Does Lily expect to file taxes? No

Does Lily expect to be claimed as a tax dependent? Yes

Does Lily meet any of the tax dependent exceptions? Yes

Lily expects to be claimed by someone other than a spouse, or biological,

adopted, or stepparent. Lily is being claimed by her grandmother. Non-filer

rules apply.

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Lily’s Household: Lily and Marcia

Household Determination

Appli

cant MAGI Household Carol Marcia Lily Family Size

Carol x x x 3

Marcia x x x 3

Lily x x 2

Rose’s household

Rose (48), Rose’s daughter Alice, (17), Alice’s daughter Kitty (1), are in the

household. Rose claims Alice as a tax dependent. Kitty is claimed by her father

Dennis (20), who does not reside in the household.

1. Rose’s household

Does Rose expect to file taxes? Yes

Does Rose expect to be claimed as a tax dependent? No

Rose’s Household is the tax household: Rose and Alice

2. Alice’s household

Does Alice expect to file taxes? No

Does Alice expect to be claimed as a tax dependent? Yes

Does Alice meet any of the tax dependent exceptions? No

Alice’s Household is the tax household of the person who claims her as a

dependent: Alice and Rose

3. Kitty’s household

Does Kitty expect to file taxes? No

Does Kitty expect to be claimed as a tax dependent? Yes

Does Kitty meet any of the tax dependent exceptions? Yes

Kitty expects to be claimed by a non-custodial parent. Non-filer rules apply.

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Kitty’s Household: Kitty and Alice

Household Determination

Appli

cant MAGI

Household

Rose Alice Kitty Family

Size

Rose x x 2

Alice x x 2

Kitty x x 2

Dennis’ Household

Dennis (20) and Dennis’ daughter Lynn (3) are in the household. Dennis claims

Lynn as a tax dependent. Dennis also claims his other daughter Kitty (1) who

lives in the household with her mother.

1. Dennis’ household

Does Dennis expect to file taxes? Yes

Does Dennis expect to be claimed as a tax dependent? No

Dennis’ Household is his tax household: Dennis, Lynn and Kitty.

2. Lynn’s household

Does Lynn expect to file taxes? No

Does Lynn expect to be claimed as a tax dependent? Yes

Does Lynn meet any of the tax dependent exceptions? No

Lynn’s Household is the tax household of the person who claims her as a

dependent: Lynn, Dennis and Kitty.

Household Determination

Appli

cant MAGI Household Dennis Lynn Kitty Family size

Dennis x x x 3

Lynn x x x 3

Jan’s household

Jan (45), her boyfriend Phil, (49), Jan’s son Mike (16), Phil’s Son Brett (14), Jan

and Phil’s daughter, Emma (4) are in the household. Jan claims Mike as a tax

dependent. Phil claims Brett and Emma as tax dependents.

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1. Jan’s household

Does Jan expect to file taxes? Yes

Does Jan expect to be claimed as a tax dependent? No

Jan’s Household is her tax household: Jan and Mike. Jan and Phil are

not married, so Phil is not included in Jan’s household.

2. Phil’s household

Does Phil expect to file taxes? Yes

Does Phil expect to be claimed as a tax dependent? No

Phil’s Household is his tax household: Phil, Brett, and Emma. Phil and

Jan are not married, so Jan is not included in Phil’s household

3. Mike’s household

Does Mike expect to file taxes? Yes

Does Mike expect to be claimed as a tax dependent? Yes

Does Mike meet any of the tax dependent exceptions? No

Mike’s Household is the tax household of the person who claims him as a

dependent: Mike and Jan

4. Brett’s household

Does Brett expect to file taxes? No

Does Brett expect to be claimed as a tax dependent? Yes

Does Brett meet any of the tax dependent exceptions? No

Brett’s Household is the tax household of the person who claims him as a

dependent: Brett, Phil, and Emma

5. Emma’s household

Does Emma expect to file taxes? No

Does Emma expect to be claimed as a tax dependent? Yes

Does Emma meet any of the tax dependent exceptions? Yes

Emma is living with two parents, but the parents do not expect to file a joint

tax return. See IV.A.3.b. above. Non-filer rules apply.

Emma’s Household: Emma, Jan, Phil, Mike and Brett

Household Determination

Ap

pli

can

t

MAGI Household Jan Phil Mike Brett Emma Family

Size

Jan x x 2

Phil x x x 3

Mike x x 2

Brett x x x 3

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Emma x x x x x 5

Patsy’s household

Patsy (45), Patsy’s daughter Cindy (20), and Patsy’s son Greg (16), are all in

the household. Patsy does not expect to file taxes or be claimed as a tax

dependent.

1. Patsy’s household

Does Patsy expect to file taxes? No

Does Patsy expect to be claimed as a tax dependent? No

Patsy’s household is established using the non-filer rules: Patsy and Greg.

Cindy is not included in the household because she is not a Medicaid age

child or sibling under age 19.

2. Cindy’s household

Does Cindy expect to file taxes? No

Does Cindy expect to be claimed as a tax dependent? No

Cindy’s household: Cindy

3. Greg’s Household

Does Greg expect to file taxes? No

Does Greg expect to be claimed as a tax dependent? No

Greg’s Household: Greg and Patsy. Cindy is not included in the

household because she is not a Medicaid age child or sibling under age 19.

Household Determination

Appli

cant MAGI Household Patsy Cindy Greg Family size

Patsy x x 2

Cindy x 1

Greg x x 2

Whitney’s Household

Whitney (45), Whitney’s sons, Paul (15) and Jason (12) are in the household.

Jason receives SSI benefits. Whitney claims both her sons as tax dependents.

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1. Whitney’s household

Does Whitney expect to file taxes? Yes

Does Whitney expect to be claimed as a tax dependent? No

Whitney’s household is her tax household: Whitney, Paul and Jason

2. Paul’s household

Does Paul expect to file taxes? No

Does Paul expect to be claimed as a tax dependent? Yes

Does Paul meet any of the tax dependent exceptions? No.

Paul’s household is the tax household of the person who claims him as a

dependent: Paul, Whitney and Jason.

Although Jason is a SSI recipient and MAGI methodology does not apply when

determining his eligibility, he is included in the family size when determining

eligibility for another applicant/beneficiary.

Household Determination

Appli

cant MAGI Household Whitney Paul Jason Family Size

Whitney x x x 3

Paul x x x 3

Jason (SSI recipient)

Sandy’s Household

Sandy (45), her husband Ben (46), and their pregnant daughter Samantha (17)

are in the household. Sandy, Ben and Samantha do not expect to file taxes nor

be claimed as tax dependents.

1. Sandy’s household

Does Sandy expect to file taxes? No

Does Sandy expect to be claimed as a tax dependent? No

Sandy’s household is established using non-filer rules: Sandy, Ben and

Samantha.

2. Ben’s household

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Does Ben expect to file taxes? No

Does Ben expect to be claimed as a tax dependent? No

Ben’s Household is established using non-filer rules: Ben, Sandy and

Samantha

3. Samantha’s household

Does Samantha expect to file taxes? No

Does Samantha expect to be claimed as a tax dependent? No

Samantha’s Household is established using non-filer rules: Samantha, her

unborn, Sandy and Ben. Since she is pregnant, the unborn is counted in

her household.

Household Determination

Appli

cant MAGI

Household

Sandy Ben Samantha Family Size

Sandy x x x 3

Ben x x x 3

Samantha x x x +1 4

IV. MAGI Income

The term “Modified Adjusted Gross Income” (MAGI) refers to a methodology of

determining if an individual is eligible for medical assistance. This section provides

general income guidelines for MAGI.

A. Establish and evaluate the current and representative estimate of gross earned

and unearned income that will be available to the household during the

certification period.

B. Guidelines of what types of income are countable are outlined in this section.

C. Electronic data sources should be used to determine eligibility. Additional

information is only requested when eligibility cannot be determined using

electronic data sources.

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D. The agency may not deny or terminate eligibility or reduce the beneficiary’s

benefits based on information received from electronic data source. The agency

must request for additional information to determine eligibility.

MAGI Countable Income

Source Definition Earned/

Unearned

Special Base

Period & Budget

Verification

Sources

Achieving A

Better Life

Experience

(ABLE ACT)

Distribution

The Achieving a

Better Life

Experience

(ABLE) Act is a

federal program

that was signed

into law

December of

2014. ABLE

gives individuals

who were

determined

disabled prior to

their 26th

birthday, and

their families,

the opportunity

to save for the

future and fund

essential

disability related

expenses

without

impacting

eligibility for

Medicaid.

Unearned Any taxable

portion of

distributions,

regardless the

amount, is

countable income

when determining

or re-determining

MAGI program

eligibility.

a. Obtain the prior

year 1040 Tax

Form.

b. Any amount

claimed on line 21

of a tax return and

labeled “ABLE” is

countable income.

The amount is

prorated over a 12-

month period.

Alimony and

Spousal

Support

Alimony

payment

received from

the former

spouse.

Unearned Court documents or

other records of

source.

Annuity

Payments

A financial

product that pays

out a fixed

stream of

payments to an

individual.

Unearned Annuity statement

or other records of

source.

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Bitwage –

Virtual Wage

Employers may

pay their

employee with

Bitcoins. The

employee may

receive their

salary in their

bank account,

cloud saving

account, digital

currency or a

Bitpay debit

card.

Earned Earning statement

or other records of

source.

Difficulty of

Care Payments

A payment when

an applicant

/beneficiary

(a/b) provides

care to an

individual who

has a physical,

or emotional

handicap and

does not live

with the

recipient.

Earned

Form 1099-MISC

or earning

statement.

Foreign Earned

Income

A U.S. citizen or

U.S. resident

alien who

receives earned

income from

another country.

Earned Earning statement

or other records of

source.

Gambling

Winnings

Any money the

(a/b) wins from

gambling or

wagering.

Unearned W-2G or earning

statement.

Investment

Income/

Ordinary

Dividends/

Qualified

Dividends

Taxable income,

interest and

dividends.

Earned 1099 Form or

earning statements.

IRA

Distributions

Money that is

distributed from

a/b’s IRA.

Unearned 1099 Form-R or

financial statement.

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Lump Sum

Payments (non-

recurring)

This is income

that is received

in a one-time

taxable payment

and is

nonrecurring.

Unearned Counted only in

the month received

if taxable; coverts

to resource next

month.

Not counted if not

taxable.

Use the documents

that are provided

from the

beneficiary.

Net Capital

Gains

The amount by

which the net

long-term capital

gain for the year

is more than the

net short-term

capital loss for

the year.

Earned Profit after

subtracting capital

losses.

Form 1099-B, Form

1099-DIV or

federal tax return.

Other Taxable

Income

Canceled debts,

court awards or

jury duty pay not

given to an

employer.

Earned Court documents or

earning statement.

Pension A retirement

plan that

provides

monthly income

in retirement.

Earned 1099-R, award

letter, or earning

statement.

Rental Income Income from

property owned

by the a/b. If the

a/b has an

ownership

interest in

property that

produces

income, the a/b

also has a legal

interest in the

income.

Unearned 1. Count rental

income as

unearned income if

the a/b rents

property,

machinery, rooms,

etc. and rental is

not done as a

business.

2. Count rental

income as self-

employment if the

a/b has a property

rental business,

rental service, etc.

• Establish gross

receipts.

• Subtract

allowable

Form 1099-MISC,

federal tax return or

other records of

source.

18

operational

expenses.

• Project over 12

months to

derive gross

monthly

income.

Retirement

Benefits

Only those that

are taxable

Unearned Form 1099-R or

earning statement.

Royalties

(Earned)

Royalties

include

compensation

paid to the

owner for the

use of property,

usually

copyrighted

material (e.g.,

books, music,

and art) or

natural resources

(e.g., minerals,

oil, gravel or

timber).

Royalty

compensation

may be

expressed as a

percentage of

receipts from

using the

property or as an

amount

per unit

produced.

Royalties are

earned income

when they are

received:

a. As part of a

trade or

business, or

b. By an

individual in

connection with

Earned Verify that

payments received

meet the definition

of royalty by

examining the

agreement

between the parties

involved or

documents in the

a/b or financially

responsible

person’s

possession. Some

documents

concerning royalty

payments will

provide both a

gross and a net

payment amount.

When the

difference between

the gross and the

net figures is due

to income taxes

withheld or

windfall profit tax

deductions, use the

gross figure when

determining

amount of income

to budget. If the

agreement or

documents are

unclear,

unavailable, or

informal, contact

Form 1099-MISC,

federal tax return or

other records of

source.

19

any publication

of his/her work.

the company or

source of the

payment.

Royalties

(Unearned)

Royalties are

unearned income

unless they are

received as part

of a trade or

business, or

received by an

individual in

connection with

any publication

of

his/her work.

Unearned An outright sale of

natural resources

by the owner of

the land or by the

owner of the rights

to use of the land

constitutes a

conversion of a

resource.

Proceeds from a

conversion of a

resource are not

income.

To be considered

royalties,

payments for the

use of natural

resources must be

received:

a. Under a formal

or informal

agreement

whereby the owner

authorizes

another individual

to manage and

extract a product

(timber or oil) and

b. In an amount

that is dependent

on the amount of

the product

actually

extracted.

Form 1099-MISC,

federal tax return or

other records of

source.

Self-

Employment

Income

Income from

being employed

in one's own

trade,

profession, or

business; not by

an employer.

This includes:

Earned 1. If the tax return

is not available,

use record from

the previous 12

months if

representative.

• Establish gross

receipts.

Self-employment

records or federal

tax return.

20

•Selling

recyclables,

•Babysitting in

one’s own home,

•Roomer/boarde

r income,

•Farm/Commerc

ial Fishing

Income,

•Adjusted Gross

Income from

Taxable Self-

Employment.

• Subtract

allowable

operational

expenses.

• Project over 12

months to

derive gross

monthly

income.

2. If in business

for less than 12

months, use the

provided

documents.

• Establish gross

receipts.

• Subtract

allowable

operational

expenses.

• Project over

countable

months to

derive gross

monthly

income.

Severance Pay Payment made

by an employer

to employee

whose

employment is

terminated

independently of

their wishes.

Unearned Count in the

month of receipt.

Verification from

employer or

earning statement.

Social Security

Benefits

Social Security

Disability

Income (SSDI)

and Social

Security

Retirement,

Survivors, and

Disability

Insurance

(RSDI).

Unearned Electronic sources,

Social Security

Administration

payment documents

or federal tax

return.

21

State and Local

Income Taxes

Taxable refunds,

credits, or

offsets of state

and local income

taxes.

Unearned Count in the

month of receipt.

Federal tax return

line 10 on the 1040

Tax form.

Taxable

Interest or Tax-

Exempt

Interest

Taxable Interest

is included in the

adjusted gross

income.

Tax-exempt

interest is not

included in the

adjusted gross

income.

Earned Form 1099-INT or

federal tax return.

Tribal Gaming

Per Capita

Payment.

These payments

may be Indian

Gaming

proceeds, Indian

Tribal

distribution

and/or Tribal

American

distribution.

Unearned Counted only in

the month

received; coverts

to resource next

month.

Form 1099-Misc or

other records of

source.

Unemployment

Benefits

Public or private

income received

by an individual

as compensation

for loss of

employment due

to layoff,

suspension, or

firing. It may

include

additional

amounts paid by

unions or

employers.

Unearned Payment statement

or federal tax

return.

Wages/Salary

(before taxes

are taken out)

Adjusted Gross

Income

(AGI)Wages,

pay advances,

attendant care

payment,

commercial

fisherman,

Earned Temporary

Census Wages are

non-countable.

Electronic sources,

pay stubs, employer

verifications,

records, or federal

tax return.

22

contract wages,

migrant income,

seasonal

employment,

permanent

census income,

commissions,

sick pay,

vacation pay,

strike duty,

guardianship

payments, which

is income

received as a

guardian to take

care of

dependent,

babysitting

outside of the

a/b’s home.

MAGI Non-Countable Income

Source Definition

American

Indian/Alaska Native

Land Payments

Payments derived from American Indian/Alaska Native

lands, natural resources, trust settlements or traditional/

cultural activities.

Cash Contribution Cash support provide by a tax filer to a tax dependent who is

not a child of the tax filer (biological, adopted or step)

Child Support

Difficulty of Care

Payments

Caregiver lives with the recipients and receiving Difficulty of

Care Payments.

Disaster

Assistance/FEMA

Payments

Includes federal emergency situation such as disaster, natural

catastrophe, or emergency that the President determines as

needing federal assistance.

Educational

Scholarships,

Awards, Fellowships

This may be verified by a Tuition Statement form (T-1098).

Federal Tax Credits

and Refunds

Gifts and Loans This includes “Go Fund Me” accounts.

Inheritances

Life Insurance,

Accident Insurance,

or Health Insurance

Salary Deferrals When benefits are provided by an employer for the employee

as a

23

contribution or as part of a salary reduction agreement with

the employee, the benefit is considered as non-countable

earned income.

• Cafeteria/Flexible Spending

• Contributions to 401 (k)

• Pre-Tax Retirement Contributions

Special Government

Compensation

Includes Payments from Alaska Native Claims Settlement

Act, Payments to Victims of Nazi Persecution, Radiation

Exposure Compensation Act, Restitution under the Civil

Liberties Act of 1988, Relocation/Acquisition Act Payments,

Wartime Relocation of Civilian's Law Payments, Agent

Orange and allowances paid under the law to Vietnam

veterans’ child(ren) born with spina bifida and other birth

defects.

Temporary

Assistance to Needy

Family (TANF) and

Other Government

Cash Assistance

A program to help needy families achieve self-sufficiency.

Examples of Government Cash Assistance:

Housing allowance from the local Housing Authority,

Crisis Intervention Program (CIP) voucher payment

Veterans Benefits

Worker’s

Compensation

Payments

V. WHOSE INCOME COUNTS WHEN DETERMINING HOUSEHOLD INCOME

This section explains how to determine whose income counts in the tax-filer or non-filer

household.

A. When using a tax household, do not count income of tax dependents unless they

expect to file a tax return.

B. When using a non-filer household, if the parent(s) is in the household, do not

count the income of the child unless the child expects to file taxes.

C. When using a non-filer household, if the parent is not in the household, count

income of child under 19 and of all siblings under age 19 for all of them. Also,

include income of spouse of the child.

VI. COUNTING INCOME

The following guide illustrates how to determine whose income counts in the tax-filer or

non-filer household. Counting income depends on the type of household (tax or non-filer)

and which individual is involved. See chart below for application of the rules.

24

Counting Income Tax Household

Tax Filer(s) Tax Dependent – child of tax filer – does not

meet an exception

Tax

Household

Count income of tax filer and co-

filer spouse. Include live in spouse’s

income if not already included in tax

HH.

Only count income of tax dependents

who expect to file a tax return.

Count income of tax filer(s)

Count income of the tax dependent applicant,

and other tax dependents who expect to file a

tax return. Count the income of the tax

dependent’s spouse if not included in the tax

household.

Counting Income Non- Filer Household

Tax Dependent – not child of

tax filer

(non-filer rules)

Adult – age 19 or

older

Medicaid age child – under

age 19

Non-filer rules Count income for own

household regardless of

whether they expect to file

taxes and count income of live-

in spouse.

If the tax dependent has

children under age 19 in the

household, count income of

children under age 19 if they

expect to file return.

If the tax dependent is under

age 19 (see last column for

Medicaid age child-under age

19)

Count income of

applicant and

spouse, if in

home.

Count income of

children in

household under

19 only if expect

to file return

If parent(s) is not in the

household count income

for own household

regardless of whether they

expect to file taxes and

count income of live in

spouse and live in siblings

under age 19.

If the Medicaid age child

has children under age 19,

count income of children

under age 19 if expect to

file return.

If parent(s) is in the

household, count the

income of the parent(s). Do

not count income of the

child and siblings under

25

age 19 unless they expect

to file a tax return.

VI. MAGI BUDGETING

The budgeting process begins after the household composition has been determined and

determining whose income counts. Budgeting is the process of determining a best

estimate of income an individual or household will receive. Use prospective budgeting

for Modified Adjusted Gross Income (MAGI). Prospective budgeting is a process of

determining countable income for the benefit month based on anticipated income

expected to be received during the certification period.

VII. BASE PERIODS

Base periods are the periods of time that are the basis for determining income eligibility.

The base period establishes a set period of time for caseworkers to create a “snapshot” of

an applicant/beneficiary’s income and for which income must be verified.

The base period should be an accurate representation of the income the household is

expected to have available during the ongoing certification period.

A. Representative Income

Represents the household’s expected income during the certification period.

The following base periods should be used for representative income received:

1. The base period for most income is the month prior to the month of

application or redetermination.

2. The base period for spousal support and alimony is the 3 months prior to the

month of application or redetermination, if representative.

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3. If the income is received annually or from self-employment, the base period

is 12 months or the number of months in operation if less than 12 months.

B. Special Base Periods

Certain types of income require special base periods, particularly if the income is not

stable or predictable. Refer to MA-3321, MAGI Medicaid/NCHC Income Limits.

C. Non-Representative Income

Income from the base period that is received irregularly, has changed or terminated

and cannot be reasonably expected to be available to the household during the

certification period.

The following base periods should be used for representative income received:

1. Explore alternative budgeting methods for projecting or averaging income.

2. Determine which budgeting method is the most representative estimate of the

household’s countable income over the certification period.

3. Project income using electronic data sources

4. Only ask the applicant/beneficiary to provide verification:

a. When electronic data sources are unavailable, and the information is not

located in the local agency, or

b. When income is not reasonably compatible with self-attestation.

D. Retroactive

The 1, 2, or 3 months prior to the application month.

VIII. INCOME BUDGETING

Most income falls into one of the following three categories below. However, for those

rare instances that the income does not fall into one of these three categories, the

caseworker should use reason and logic to determine and document calculation of gross

income.

The caseworker’s goal is to determine a representative amount and frequency of the gross

income that is available to the household during their certification period.

27

A. Ongoing Income

Income that the household has been or expects to receive on regular ongoing bases.

This income can fluctuate across pay periods. The caseworker should use averaging

to determine the amount of gross income available to the household for each pay

period.

1. Calculation:

a. Average the representative income to establish an accurate representation

of the income expected to be received each pay period.

b. Total the gross income for each pay received during the base period and

divide by the total number of pay periods to reach an average income

expected to be received during the certification period . Do not round.

c. If the base period contains a pay period of $0 that is representative of the

regular ongoing pay use $0 in your averaging.

d. If the $0 pay is not representative, then do not use that pay period and

document the case record thoroughly.

2. The caseworker and/or NC FAST uses the following formulas to convert

income to a monthly amount.

a. If received weekly, multiply by 4.3

b. If received biweekly, multiply by 2.15

c. If received semi-monthly, multiply by 2

d. If received quarterly, divide by 3

e. If received monthly, use the monthly gross

f. If received semi-annually, divide by 6

g. If received annually, divide by 12

B. Ongoing Income

Income that was not previously available to the household but is now or will be

available to them during their certification period.

28

Calculation

1. Use all representative (full) pays received to date to average gross income

across pay periods.

2. If only a partial pay period is available, use the best available information

regarding the number of hours, rate of pay, and frequency of pay expected to

be received over the certification period

C. Ongoing Income

Income that the household has previously received that has terminated or will

terminate during the certification period.

1. Individuals Under 19

a. Do not count terminated income. Project only the income that can be

reasonably anticipated to continue for the certification period, even if the

household member has not yet received the last pay.

b. Do not react to changes (new, changed and/or terminated) in income

during the certification period due to continuous eligibility, regardless of

whether change is an increase or decrease.

2. Individuals 19 and Older

a. Count terminated income through the month household receives final pay

from the source.

b. Count new/changed income the month following the month of change for

application, redeterminations, and changes.

D. Retroactive Income

1. Count income (new, changed and/or terminated) received during the base

period, whether change is an increase or decrease.

2. In situations where electronic data sources cause ineligibility, the actual

income must be requested for the 1, 2, and/or 3 months.

• An application/recertification cannot be denied or terminated based on

electronic data source.

29

IX. 5% INCOME DISREGARD

A. The 5% income disregard is applied when the individual fails the income test. A

5% income disregard is applied only if an applicant/beneficiary’s income

exceeds the highest comprehensive Medicaid program income limit for that

individual.

B. The 5% income disregard is based on the applicable income limit for the family

size.

C. Do not apply the 5% income disregard if the individual is eligible for full

Medicaid benefits without the disregard.

D. The 5% income disregard is applied if income exceeds the NCHC limit.

X. BUDGETING EXAMPLES

A. Annie (35), Annie’s son Jacob (10) and Annie’s daughter Miley (7) are in the

household. Annie does not expect to file taxes or be claimed as a tax dependent.

Family’s financial situation:

$100.00/weekly-Annie’s salary from housecleaning

$70.00/Weekly-Babysitting

$800.00/monthly-child support payments received by Annie for Jacob and Miley

Annie is a non-filer household. Her income counts in her household. Child support

payments received are not counted when applying MAGI methodology.

Annie’s income

Monthly gross (100 x 4.3) Housecleaning $430.00

Monthly gross (70 x 4.3) Babysitting $301.00

MAGI Income $731.00

Annie’s MAGI income exceeds the income limit for MAF C/N of $667.00 for a

family size of 3. Apply the 5% disregard. Refer to MA-3321, MAGI

Medicaid/NCHC Income Limits.

Annie’s MAGI income

Subtract 5% income disregard for a household of 3

= Annie’s Countable income

Annie countable income is less than the MAF-C income limit of for a family size of

3.

Jacob’s income

Jacob’s household and MAGI income is the same as Annie’s. Jacob’s income is less

than the MIC-1 income limit of $2304.00 for a family size of 3. Do not apply the

30

5% disregard. Determine which program Jacob is eligible for based on his MAGI

income. His income is less than the MIC-N limit for a family size of 3.

Miley’s income Miley’s household and MAGI income is the same as Annie’s.

Miley’s income is less than the MIC-1 income limit of $2194.00 for a family size of

3. Do not apply the 5% disregard. Determine which program Miley is eligible for

based on her MAGI income. Her income is less than the MIC-N income limit for a

family size of 3.

B. Mary (51), Mary’s son Bill (22), Mary’s Nephew Ned (10) and Mary’s niece

Nancy (10) are in the household. Mary claims all as tax dependents.

Family’s financial situation:

$800.00/monthly gross income-Mary’s income from her home business after

allowable self-employment tax deductions

$400.00/monthly gross income-Bill’s income from weekend jobs.

$730.00/monthly gross income- Ned’s SSA survivor’s benefits

$730.00/monthly gross income- Nancy’s SSA survivor’s benefits

Mary is a tax household and she is the filer, so her MAGI income is her income and

income of the applicant’s other tax dependents who file a tax return. Since Bill, Ned

and Nancy are tax dependents and do not expect to file taxes, their income is not

counted for Mary.

Mary’s income

MAGI income $800.00

Mary’s MAGI income exceeds the MAF-C/N income limit for a family size of 4.

Since Mary’s MAGI income exceeds the limit, apply the 5% disregard. Refer to

MA-3321, MAGI Medicaid/NCHC Income Limits.

May’s MAGI income

Subtract 5% income disregard for a household of 4

= Mary’s Countable income

Mary’s countable income is less than the MAF-C/N income limit for a family size of

4.

Bill’s income

Bill is a child and a tax dependent of his mother. His household and MAGI income

are the same as his mother’s. Since Bill is a tax dependent and he does not expect to

31

file taxes, his income is not counted for himself or for Mary. Ned and Nancy also do

not expect to file taxes.

Although his countable income is less than the MAF-C/N income limit for a family

size of 4, Bill does not qualify because he does not qualify as a caretaker.

Bill’s MAGI income of $800.00 is less than the MAF-D income limit for a family

size of 2. The disregard is not applied as his income does not exceed the income

limit for Family Planning Medicaid.

Ned’s income

Monthly gross Ned $730.00

Monthly gross Nancy $730.00

MAGI income $1460.00

Mary claims Ned on her taxes but Ned meets an exception, he is a tax dependent of

someone other than a spouse or parent. Since he is under the age 19 and his parent (s)

are not in the household, his income counts for him and his sibling’s household

regardless of whether he expects to file a tax return.

Ned’s MAGI income is less than the MIC-1 income limit for a family size of 2.

Although Ned would be eligible for MIC-N, with the 5% disregard, do not apply

the disregard because he is under the MIC-1 income limit.

Nancy’s income

Nancy’s MAGI income and household is the same as Ned’s because they are under

19 in the same household.

Nancy’s MAGI income is less than the MIC-1 income limit for a family size of 2.

Although Nancy would be eligible for MIC-N, with the 5% disregard, do not

apply the disregard because she is under MIC-1 income limit.

C. Carol (49), Carol’s daughter Marcia (17), Marcia’s daughter, Lily (2), are in the

household. Carol claims all as tax dependents.

Family’s financial situation:

$850.00/ monthly gross income-Carol’s salary

$160.00/monthly-Carol’s pre-tax retirement contributions

Carol is a tax household and she is the filer, so her MAGI income is her income and

income of the applicant’s other tax dependents who file a tax return. Since Marcia is a

tax dependent and she does not expect to file taxes, her income is not counted for

Carol.

32

Carol’s income

Monthly gross $850.00

Minus pre-tax retirement contribution -$160.00

MAGI income $690.00

Carol’s MAGI income exceeds the MAF-C/N income limit of $667 for a family size

of 3. Since Carol’s income exceeds the income limit for MAF C/N, apply the 5%

disregard. Refer to MA-3321, MAGI Medicaid/NCHC Income Limits.

Carol’s MAGI income

Subtract 5% disregard for a household of 3

= Carol’s Countable income

Carol’s countable income is less than the MAF-C/N income limit for a family size of

3.

Marcia’s income

Marcia is a child and a tax dependent of her mother. Her household and MAGI

income are the same as her mother. Since Marcia is a tax dependent and she does not

expect to file taxes, her income is not counted for herself or for Carol.

Marcia’s MAGI income is less than the MIC-1 income limit for a family size of 3. Do

not apply the 5% disregard. Determine which program Marcia is eligible for based

on her MAGI income. Her income of $690.00 is less than the MIC-N income limit.

Lily’s income

MAGI income $0.00

Carol claims Lily on her taxes but Lily meets an exception, she is a tax dependent of

someone other than a spouse or parent. Non-filer rules apply. Her household is Lily

and her mother, Marcia. Carol is not included in her household and her income is not

counted.

Lily’s MAGI income is less than the MAF-C income limit for a family size of 2. Do

not apply the 5% disregard.

D. Rose (48), Rose’s daughter Alice, (17), Alice’s daughter Kitty (1), are in the

household. Rose claims Alice as a tax dependent. Kitty is claimed by her father

Dennis (20), who does not reside in the household.

Family’s financial situation:

$1560.00/monthly gross income-Rose’s salary

$600.00/monthly - Child support payments received by Rose for Alice.

33

Rose is an adult in a tax-filer household. Her income counts in her household.

However, under MAGI rules, child support payments received are not counted.

Rose’s income

MAGI income $1560.00

Rose’s MAGI income exceeds the MAF-C/N income limit for a family size of 2.

Since Rose’s MAGI income exceeds the MAF C/N, apply the 5% disregard.

Refer to MA-3321, MAGI Medicaid/NCHC Income Limits.

Rose’s MAGI income

Subtract 5 % disregard for a household of 2

= Rose’s Countable income

Rose’s countable income exceeds the income limit for a family size of 2 for MAF-C

with the 5% disregard.

Rose’s MAGI income of $1560.00 is less than the MAF-D income limit for a family

size of 2. The disregard is not applied as her income does not exceed the income

limit for Family Planning Medicaid.

Alice’s income

Alice is a child and a tax dependent of her mother. Her household and MAGI income

is the same as her mother’s. Since Alice is a tax dependent and she does not expect to

file taxes, her income is not counted for herself or Rose.

Alice’s MAGI income is less than the MIC-1 income limit for a family size of 2. Do

not apply the 5% disregard.

Kitty’s income

Since Kitty is being claimed on her father’s taxes, who does not live in the household,

and her mother Alice does not have any income of her own, Kitty’s countable income

is $0. Rose is not included in Kitty’s household, so Rose’s income is not counted.

Kitty’s countable income is less than the MAF-C income limit for a family size of 2.

E. Dennis (20) and Dennis’ daughter Lynn (3) are in the household. Dennis claims

Lynn as a tax dependent. Dennis also claims his other daughter Kitty (1) who

lives in the household with her mother (see example D above, Rose’s household).

Family’s financial situation:

$2390.00/monthly gross income-Dennis’ salary

Dennis is a tax household and he is the filer, so his MAGI income is his income and

the income of the applicant’s other tax dependents who file a tax return. Kitty is

included in Dennis’ household.

34

Dennis’ income

MAGI income $2390.00

Dennis’ MAGI income exceeds the MAF-C/N income limit for a family size of 3.

Apply the 5% disregard. Refer to MA-3321, MAGI Medicaid/NCHC Income

Limits.

Dennis’ MAGI income

Subtract 5% disregard for a household of 3

= Dennis’ Countable income

Dennis’ countable income exceeds the income limit for a family size of 3 for MAF-C

with the 5% disregard.

Dennis’s MAGI income of $2390 is less than the MAF-D income limit for a family

size of 3. The disregard is not applied as his income does not exceed the income

limit for Family Planning Medicaid.

Lynn’s income

Lynn is a child and is a tax dependent of her father. Her household and MAGI

income is the same as her father’s.

Lynn’s MAGI income is less than the MIC-1 income limit for a family size of 3.

F. Jan (45), her boyfriend Phil, (49), Jan’s son Mike (16), Phil’s Son Brett (14), Jan

and Phil’s daughter, Emma (4) are in the household. Jan claims Mike as a tax

dependent. Mike expects to file taxes. Phil claims Brett and Emma as tax

dependents.

Family’s financial situation:

$1200.00/monthly gross income - Jan’s salary

$750.00/monthly gross income – Phil’s salary

$50.00/monthly pre-tax retirement contributions for Phil

$450.00/monthly gross income – Mike’s salary

Jan is a tax household and she is the filer, so her MAGI income is her income and the

income of the applicant’s other tax dependents who file a tax return. Mike expects to

file a tax return, so his income is included in Jan’s household income. Phil’s income

is not counted because he is not married to Jan and is not in her household.

Jan’s income

Jan’s monthly gross $1200.00

Mike’s monthly gross $ 450.00

35

MAGI income $1650.00

Jan’s MAGI income exceeds the MAF-C/N income limit for a family size of 2.

Apply the 5% disregard. Refer to MA-3321, MAGI Medicaid/NCHC Income

Limits.

Jan’s MAGI income

Subtract 5 % disregard for a household of 2

= Jan’s Countable income

Jan’s countable income exceeds the MAF-C/N income limit for a family size of 2

with the 5% disregard.

Jan’s MAGI income of $1650 is less than the MAF-D income limit for a family size

of 2. The disregard is not applied as her income does not exceed the income limit

for Family Planning Medicaid.

Mike’s income

Mike is a child and a tax dependent of his mother. His household and MAGI income

is the same as his mother’s.

Mike’s MAGI income is less than the MIC-1 income limit for a family size of 2. Do

not apply the 5% disregard.

Phil’s income

Phil is a tax household and he is the filer, so his MAGI income is his income and the

income of the applicant’s other tax dependents who file a tax return. Jan’s income is

not counted because she is not married to Phil and is not in his household.

Phil’s monthly gross $ 750.00

Minus pre-tax retirement contributions -$ 50.00

MAGI income $ 700.00

Phil’s MAGI income exceeds the MAF-C/N income limit for a family size of 3.

Apply the 5% disregard. Refer to MA-3321, MAGI Medicaid/NCHC Income

Limits.

Phil’s MAGI income

Subtract 5% disregard for a household of 3

= Phil’s Countable income

Phil’s countable income is less than the MAF-C income limit for a family size of 3.

Brett’s income

36

Brett is a child and a tax dependent of his father. His household and MAGI income is

the same as his father’s.

Brett’s countable income is less than the MIC-1 income limit for a family size of 3.

Do not apply the 5% disregard. Determine which program Brett is eligible for

based on his MAGI income. His income of $700.00 is less than the MIC-N income

limit.

Emma’s income

Jan’s monthly gross $1200.00

Phil’s monthly gross $750.00

Mike’s monthly gross $450.00

Mike’s pre-tax contributions -$ 50.00

MAGI income $ 2350.00

Emma is a child and a tax dependent who meets an exception; therefore, non-filer

rules are applied. Her MAGI income consists of her parent’s income and Mike’s

income because he expects to file taxes.

Emma’s MAGI income is less than the MIC-1 income limit for a family size of 5. Do

not apply the 5% disregard. Determine which program Emma’s is eligible for based

on her MAGI income. Her income of $2350.00 is less than the MIC-N.

G. Patsy (45), Patsy’s daughter Cindy (20), and Patsy’s son Greg (16), are all in the

household. Patsy claims Greg as a tax dependent. Cindy does not expect to file

taxes or be claimed as a tax dependent.

Family’s financial situation:

$2950.00/monthly gross income –Patsy’s salary

$150.00/monthly pre-tax retirement contributions for Patsy

$375.00/monthly gross income-Cindy’s income from housecleaning.

Patsy’s income

Patsy is a tax household and she is the filer, so her MAGI income is her income and

the income of the applicant’s other tax dependents who file a tax return.

Patsy’s monthly gross $ 2950.00

Minus pre-tax retirement contributions -$ 150.00

MAGI income $ 2800.00

Patsy’s MAGI income exceeds the MAF-C/N income limit for a family size of 2.

Apply the 5% disregard. Refer to MA-3321, MAGI Medicaid/NCHC Income

Limits.

37

Patsy’s MAGI income

Subtract 5% disregard for a household of 2

= Patsy’s Countable income

Patsy’s countable income exceeds the MAF-C/N income limit for a family size of 2

with the 5% disregard. Patsy income also exceeds the MAF-D income limit.

Cindy’s income

Cindy is a not tax dependent of her mother. Cindy does not expect to file taxes.

MAGI income $375.00

Cindy’s MAGI income is less than the MAF-N income limit for a family size of 1.

Do not apply the 5% disregard.

Greg’s income

Greg is a child and a tax dependent of his mother. His household and MAGI income

is the same as his mother.

MAGI income $2800.00

Greg’s MAGI income exceeds the MIC-1 income limit for a family size of 2. Apply

the 5% disregard. Refer to MA-3321, MAGI Medicaid/NCHC Income Limits.

Greg’s MAGI income

Subtract 5% disregard for a household of 2

= Greg’s Countable income

Greg’s income still exceeds the MIC-1 income limit. Greg’s MAGI income of $2800

exceeds the NCHC income limit. Apply the 5% disregard. Greg’s countable

income is now less than the NCHC income limit for a family size of 2. Greg is

eligible of MIC-K.

H. Whitney (45), Whitney’s sons, Paul (15) and Jason (12) are in the household.

Jason receives SSI benefits. Whitney claims both her sons as tax dependents.

Family financial situation:

$850.00/monthly gross income-Whitney’s salary

$150.00/monthly pre-tax retirement contributions for Whitney

$721.00/monthly-Jason’s Supplement Security income (SSI)

Whitney is a tax household and she is the filer, so her MAGI income is her income

and income of the applicant’s other tax dependents who file a tax return.

Supplemental Security Income (SSI) is not counted.

Whitney’s income

38

Whitney’s monthly gross $850.00

Minus pre-tax retirement contributions - $150.00

MAGI income $700.00

Whitney’s MAGI income exceeds the MAF-C/N income limit for a family size of 3.

Apply the 5% disregard. Refer to MA-3321, MAGI Medicaid/NCHC Income

Limits.

Whitney’s MAGI income

Subtract 5% disregard for a household of 3

= Whitney’s Countable income

Whitney’s countable income is less than MAF-C/N income limit for a family size of

3.

Paul’s income

Paul is a child and a tax dependent if his mother. His household and MAGI income is

the same as his mother’s.

Paul’s income is less than the MIC-1 income limit for a family size of 3. Do not

apply the 5% disregard. Determine which program Paul is eligible for based on his

MAGI income. His income of $700.00 is less than the MIC-N income limit.

Jason is an SSI recipient-his eligibility is not determined under MAGI.

I. Sandy (45), her husband Ben (46), and their pregnant daughter Samantha (17)

are in the household. Sandy, Ben and Samantha do not expect to file taxes nor

be claimed as tax dependents.

Family financial situation:

$1200.00/monthly gross income-Sandy’s social security benefits

$250.00/monthly gross income-Ben’s veteran’s benefits

$200.00/monthly gross income-Samantha’s income from babysitting.

Veteran benefits are not counted when applying MAGI methodology.

Sandy’s income

MAGI income $1200.00

Sandy is a non-filer household. Her countable income is her social security income.

Her spouse’s veteran benefits are non-countable under MAGI. Samantha’s income is

not counted as she does not plan to file a tax return. Sandy’s income exceeds the

MAF-C/N income limit for a family size of 3. Apply the 5% disregard. Refer to

MA-3321, MAGI Medicaid/NCHC Income Limits.

39

Sandy’s MAGI income

Subtract 5% disregard for a household of 3

= Sandy’s Countable income

Sandy’s MAGI income exceeds the MAF-C/N income limit for a family size of 3

with the 5% disregard.

Sandy’s countable income of $1200.00 is less than the MAF-D income limit for a

family size of

3. The disregard is not applied as her income does not exceed the income limit

for Family Planning Medicaid.

Ben’s income

MAGI income $1200.00

Ben is a non-filer household. His countable income is Sandy’s social security

income. His veteran’s income is non-countable under MAGI. Ben’s income exceeds

the MAF-C/N income limit of for a family size of 3. Apply the 5% disregard.

Ben’s MAGI income

Subtract 5% disregard for a household of 3

= Ben’s Countable income

Ben’s countable income exceeds the MAF-C/N income limit for a family size of 3

with the 5% disregard.

Ben’s income of $1200.00 is less than the MAF-D income limit for a family size of 3.

The disregard is not applied as his income does not exceed the income limit for

Family Planning Medicaid.

Samantha countable income

Samantha’s is a non-filer household. Her income is not counted because she is a

Medicaid aged child in the non-filer household of her parents. However, Sandy’s

income is counted in Samantha’s household. Samantha’s countable income is

different from Sandy’s and Ben’s because she is pregnant and so her household size is

4 (herself, her mother, her father and the unborn child).

MAGI income $1200.00

Samantha’s MAGI income is less than the MIC-1 income limit for a family size of 4.

Do not apply the 5% disregard. Determine which program Samantha is eligible for

based on her MAGI income. Her income of $1200.00 is less than the MIC-N income

limit.