MAGI-Based Medicaid Eligibility

What is MAGI-Based Medicaid Eligibility?

MAGI stands for Modified Adjusted Gross Income. The MAGI Medicaid program started January 1, 2014 under the Affordable Care Act (ACA). It established a uniform approach to determining a person’s household size and income for purposes of Medicaid Eligibility.

Who Can Qualify for MAGI-Based Medicaid?

MAGI-Based Eligibility applies to singles, married couples, families with children 19 and under and children up to the age of 19.
It does not apply to the elderly or people who qualify for Medicaid based on disability. The elderly and disabled fall under different Medicaid eligibility requirements.

Applicants must also meet the income requirements. There are no asset requirements.

How is Income Calculated?
MAGI modified adjusted gross income is calculated as Adjusted Gross Income plus any foreign earned income excluded from taxes, plus tax-exempt interest, plus tax-exempt social security income.

What are the Income Requirements?

Income guidelines are divided into categories based upon living arrangement and family size.

The categories are:

• Parents and Caretaker Relatives: Up to 90% of federal poverty level for their household size;
• Expansion Adults: (all adults, including Parents and Caretaker Relatives) up to 133% of the federal poverty level for their household size;
• Children with Insurance: Up to 156% of the federal poverty level for their household size;
• Pregnant Women: Up to 200% of the federal poverty level for their household size;
• Children with Insurance: Up to 206% of the federal poverty level for their household size.

Lorain County Job and Family Services provides a helpful chart setting forth the 2015 standards for MAGI Medicaid. http://www.lcdjfs.com/financial-support-services/medicaid/magi