Magi Medicaid Vs Classic Medicaid

How Much Does Magi Medicaid Cost

Module 1 Overview of Washington Apple Health (Medicaid)

Medicaid provides free health insurance to individuals who qualify based on income and family size. If you qualify for MAGI Medicaid, you may be required to enroll into a managed care plan to receive your medical services. Some services may be subject to co-payments, these co-payments can be as little as 50 cents . The maximum you will pay out of pocket for the year cannot exceed $200.

Magi Medicaid For Adults Children & Families

What does MAGI mean?

MAGI stands for Modified Adjusted Gross Income

MAGI-based budgeting is used to calculate a person’s household size and income, using federal income tax rules and a tax filer’s family size to determine eligibility for Medicaid
The MAGI Medicaid program started January 1, 2014, as part of the Affordable Care Act

Who is potentially eligible for MAGI Medicaid?

Single, childless adults

Families with children ages 19 and under
Children up to age 19

What are the income guidelines?

It depends. There are different categories of MAGI Medicaid. All guidelines are based on gross income:

Parents and Caretaker Relatives : up to 90% of the federal poverty level for their household size
Expansion Adults : 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 without Insurance: up to 206% of the federal poverty level for their household size

Below is a chart showing the 2021 standards for MAGI Medicaid eligibility:

Medicaid HH Size

Taking Advantage Of Magi

The Affordable Care Act simplified Medicare eligibility and enrollment for millions of Americans. Using MAGI for eligibility simplified the application process. The administrative burden of confirming assets was put to the wayside. Unfortunately, it also gave wealthy people the opportunity to take advantage of taxpayer dollars.

This loophole occurs because the majority of Americans now qualify for Medicaid through MAGI, which unless you are seeking long-term nursing home care no longer uses the asset test. People who are asset rich, particularly those who have investments or real estate properties, can still technically meet MAGI criteria.

Someone could own a home worth $850,000, a Lamborghini, a second vehicle, hundreds of acres of farmland, and still technically be eligible for Medicaid.

These Americans would be considered wealthy by any standards but by sheltering their net worth under the current tax laws, they would be legally eligible for Medicaid or subsidized plans through the Health Insurance Marketplace. This is the case even when they could easily dip into their assets to pay for health insurance.

If the intent is to provide health care to the most financially needy, MAGI Medicaid may need to consider how it addresses this loophole. The GOP is currently looking to repeal Obamacare which would, in effect, put an end to MAGI Medicaid altogether.

How Do I Invalidate Modified Adjusted Gross Income N01 Or N02 In Acesonline

When it has been discovered that an individual was opened on a N01 or N02 Assistance Unit in error for a particular month take the following steps:

From the Assistance Unit’s Summary page, select Demographics from the Details drop down menu.

On the Demographics page, click the checkbox next to Exclude from N01/N02 Determination in the Details section.

The page refreshes and displays the updated checkbox and the medical coverage group is invalidated for the given month.

Note:

If it is discovered the invalidation was done in error workers can go back to the AU’s Demographics page and remove the checkmark next to the Exclude from N01/N02 Determination for any given month.

Workers must go back into Healthplanfinder to invoke an eligibility call to the Eligibility Service.

The Magi Population Groups

The MAGI population groups include the following:

Pregnant women
Dependent children under the age of 19
Parents/caretaker relatives of children under 19

Applicants 65 and over, as well as applicants with Medicare, are typically budgeted as non-MAGI.
However, if such an applicant is a parent/caretaker relative with children under 19, they may choose to be classified as MAGI and MAGI budgeting rules and application and renewal procedures would apply.

Singles/Childless couples ages 19 through 64 who are not entitled to or enrolled in Medicare.

This includes SSDI beneficiaries who do not yet have Medicare.

Recommended Reading: How Much Money Disqualifies You For Medicaid

Modified Adjusted Gross Income

Your modified adjusted gross income is your AGI with excluded foreign income, non-taxable portions of your Social Security income, and tax-exempt interest.

Essentially, this adds back certain deductions from the AGI. For most people, the AGI and MAGI will be the same.

When it comes to Medicaid eligibility, however, MAGI has two components. The first is your household income, and the second is the size of your household.

If you are on your own, in a family of two, or in a family of five, you will have different qualifying MAGI levels to become eligible for these programs. Each state will have different MAGI levels too, depending on whether or not they enacted Medicaid expansion.

Qualifying For Magi Medicaid

MAGI is the new methodology for determining household composition, household size, as well as how income is counted to evaluate eligibility for MAGI Medicaid. The MAGI methodology basically follows the same rules as when a household files their federal income taxes and is based on the adjusted gross income that a filing unit reports on their federal income tax return with certain modifications, thus modified adjusted gross income MAGI. Income thresholds were expanded up to a minimum of 138% of the federal poverty levels for the MAGI Medicaid population, and could be higher depending on the applicant. In addition, the asset test was eliminated under the ACA for the MAGI groups. And immigration criteria follow the federal Medicaid immigration criteria, for the most part. For more information, see below, Qualifying for MAGI Medicaid.

Also Check: How To Apply For A Replacement Medicaid Card

Income Definitions For Marketplace And Medicaid Coverage

Financial eligibility for the premium tax credit, most categories of Medicaid, and the Childrens Health Insurance Program is determined using a tax-based measure of income called modified adjusted gross income . The following Q& A explains what income is included in MAGI.

Note that many guidelines and thresholds are indexed and change each enrollment year. For reference, please see the Yearly Income Guidelines and Thresholds Reference Guide.

How do marketplaces, Medicaid, and CHIP measure a persons income?

For the premium tax credit, most categories of Medicaid eligibility, and CHIP, all marketplaces and state Medicaid and CHIP agencies determine a households income using MAGI. States previous rules for counting income continue to apply to people who qualify for Medicaid based on age or disability or because they are children in foster care.

MAGI is adjusted gross income plus tax-exempt interest, Social Security benefits not included in gross income, and excluded foreign income. Each of these items has a specific tax definition in most cases they can be located on an individuals tax return .

FIGURE 1:Formula for Calculating Modified Adjusted Gross Income

What is adjusted gross income?

What types of income count towards MAGI?

All income is taxable unless its specifically exempted by law. Income does not only refer to cash wages. It can come in the form of money, property, or services that a person receives.

Does MAGI count any income sources that are not taxed?

Alien Emergency Medical Programs

Is Medicaid Coverage Better or Worse than Private Insurance?

AEM is for individuals who have a qualifying medical emergency and do not qualify for any other Apple Health program due to citizenship/immigration requirements. This includes qualified aliens who have not met the 5-year and are not exempt from the 5-year bar, nonpregnant nonqualified aliens, and undocumented individuals.

To qualify for AEM, an individual must have or need at least one of the following:

A qualifying emergent medical condition such as emergency room care, inpatient admission, or outpatient surgery
A cancer treatment plan
Antirejection medication for a postorgan transplant or on long-term care services *

Assessment and treatment for the COVID-19 virus**

Income qualifications are determined by the eligibility requirements and income listed below:

Modified Adjusted Gross Income Medicaid, Processed by the Washington State Health Care Authority

Individual is age 19 through 64
Individual is not eligible for Medicare and
Follows MAGI rules established through the Healthplanfinder.

Total number

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What Happens When Changes Are Reported In Washington Healthplanfinder

When changes are reported by an individual in Washington Healthplanfinder for a Modified Adjusted Gross Income Assistance Unit , and there is a related Cash, Classic Medicaid, or Basic Food AU in ACES, the system takes the appropriate action on the related AU which could include:

Overlaying some of the ACES data with the Healthplanfinder data.

Displaying some of the MAGI data in ACES.online for comparison against existing ACES data.
Generating a Barcode Tickle.
Invoking a call to the Eligibility Service for a benefit recalculation.

NOTE:

Complete And Submit An Application

Self-service application options:

Online: Log on to Georgia Gateway at to apply for benefits. Available 24/7.

Call the Customer Contact Center at to submit an application by telephone.

An application is considered filed when it has the name of the head of household, address, date and signature of the head of household or another household member and is received by DFCS.

Notice of Free Interpretation ServicesIf you have difficulty communicating with us because you do not speak English or have a disability, please notify a staff person. Free interpretation services, translated materials or other assistance is available upon request.

For additional support with requesting large print versions of DFCS applications, please visit .

DFCS Reasonable Modifications and Communication Assistance Request Form for Persons with Disabilities

Do you have a disability and need a reasonable modification or communication assistance to access DFCS services? to request a reasonable modification, communication assistance, extra help or to learn more about the rights of customers with disabilities.

Medicaid Benefit Renewal

All benefits recipients are required to undergo periodic review of continued program eligibility. A renewal form and any required accompanying verification can be submitted in Georgia Gateway or by using Form 508 the FOOD STAMP/MEDICAID/TANF Renewal Form.

Applying For Magi Medicaid

Most MAGI applicants apply online at the NY State of Health Insurance Marketplace. However, there are few exceptions. Local counties and HRA in NYC will continue to handle the following type of cases for MAGI applicants/recipients:

Medicaid spenddown participants
Managed Long-Term Care Plan participants

Assisted living participants
All Medicaid consumers who need long-term nursing home care, institutional Medicaid
Adults or children in need of waiver services

Consumers residing in a congregate care facility.

For more information, see below, Applying for MAGI Medicaid.

Medicaid And The Asset Test

What assets can you have and still qualify for Medicaid?

When it comes to non-MAGI Medicaid eligibility, both your income and your assets come into play. Most of the government programs that qualify you for Medicaid use an asset test. SSI sets the standard.

If your income and assets are above a certain level, you will not qualify for the program. In 2021, the income limit is set at $2,382 per month and the asset limits at $2,000 for an individual.

MAGI Medicaid does not cover everything. Your assets come into play when it comes to Long-Term Services and Supports , the part of Medicaid that pays for long-term care in a nursing home.

Not everything you own will count toward your assets. If you have too many assets, you will need to spend down before you will be eligible for Medicaid. How you spend down, however, is important, because you can be penalized for high-value gifts or transfers made within the past 60 months , aka the Medicaid look-back period.

Recommended Reading: Will Medicaid Pay For Cremation

How Do I Invalidate Continuous Eligibility Tracking For Children’s Washington Apple Health Modified Adjusted Gross Income In Acesonline

When it has been discovered that the CTCN period for Children’s WAH has been opened in error take the following steps:

From the client’s Summary page, select Children’s Tracking CN Medicaid from the Details drop down menu.

On the Childrens Tracking CN Medicaid page, click Cancel next to the CTCN period to be invalidated. The following message displays “You are about to end continuous eligibility tracking. This action cannot be undone. Click “OK” to end the tracking or click “Cancel” to return to the previous page.”

Note:

Click OK to invalidate the selected CTCN period for the client.

Workers must go back into Healthplanfinder to invoke an eligibility call to the Eligibility Service.

How Do I Flag An Individual To Identify That They Have Incorrectly Attested To Their Income Citizenship Or Immigration Status

When an individual has been found to have incorrectly attested to their income, citizenship or immigration status, workers with Unit Type 76 can update the Prevent WAH/MAGI Approval flag in ACES.online by taking the following steps:

On the Welcome back page, complete the following fields in the Quick Navigation section:

Select a Type of ID drop down box – Select Client.
Enter an ID field – Enter the .

Select a Page drop down box – Select Demographics.
Click the Go button and the Summary page displays.

Select the Yes radio button in the Prevent WAH/MAGI Approval field.

Note:Yes

See ACES Screens and Online pagesfor an example of pages or screens used in this chapter.

Canceling Medicaid Managed Care

1Check the date you were assigned to the HMO. If you were automatically assigned to an HMO, you only have a brief period of time to disenroll from it or switch to a different plan.XResearch source

If you wait until after that 90-day period, you won’t be able to get out of it unless you have an approved reason for needing to do so. For example, you could get out if the doctors didn’t speak your language, or if their office was too far away from your home.

2 Your state’s health department or Medicaid office will have a toll-free customer service number for you to call. This number may be on your Medicaid card, and will also be listed on any Medicaid notices you received.XResearch source

When you call, explain that you want to get out of your HMO and ask for a disenrollment form. They will mail the form to you.

3Fill out your disenrollment form. When you get the disenrollment form in the mail, fill it out immediately. You will need to provide personal identity information, such as your name and Social Security number.XResearch source

You also may be asked for the reason you’re requesting disenrollment from the HMO. If you believe you are exempt or excluded from the HMO requirements, you may need to provide additional information.

5File an appeal if your request is denied. Your state’s health care department and your HMO will review your request for disenrollment, and it may not be granted. If it is denied, you will receive a notice with the reasons why.XResearch source

What Is Modified Adjusted Gross Income Based Medical

What is Modified Adjusted Gross Income, or MAGI?

MAGI-based medical refers to Medicaid and Children’s Health Insurance Premium coverage for individuals who are relatable to Medicaid/CHIP if they are:

A child under age of 19,

A custodial parent/caretaker, or
An eligible adult between ages 19 and 65 whose income is below the Federal Poverty Level threshold for the program using the MAGI income methodology.

Also Check: Job And Family Services Ohio Medicaid

Canceling Classic Medicaid Coverage

1Determine why you qualified for Medicaid coverage. You have what may be referred to as “Classic” Medicaid or “Non-MAGI” Medicaid if you qualified for Medicaid for some reason other than your income.XResearch source

For example, you may have qualified for Medicaid coverage because you are over 65, or because you have a disability, such as blindness.

2 Going directly to your local Medicaid office often is the easiest way to cancel your coverage. You’ll have the benefit of working with a trained staff member who can assess your situation and make sure your coverage is cancelled correctly.XResearch source

There may be contact information on your Medicaid card, or on any Medicaid statements you’ve received. You can also find contact information and addresses of local offices on the website of your state’s health care department.

3Use your marketplace account to cancel online. If you’ve set up an account on your state’s health care marketplace website to manage your Medicaid, you may be able to cancel your coverage online.XResearch source

When you log in, look for a link to “Report changes” or “Edit your coverage.” Click the link and follow the prompts to cancel your Medicaid coverage.

When you cancel your coverage, check the final date that you’ll be covered under Medicaid. If you now have other health insurance, you want to make sure there’s no gap between when your Medicaid ends and your new coverage starts.

Note On Incarcerated Beneficiaries

Medicaid suspends the eligibility of Medicaid beneficiaries who are incarcerated in Rhode Island. The corrections system must provide basic healthcare for inmates, and Medicaid is responsible for reimbursing costs of acute care hospital stays of 24 hours or more provided off the premises of the corrections facility.

Medicaid coverage that has been suspended due to incarceration must be reinstated promptly upon the persons release.

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Effective Date Of Coverage

Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.

Who Is Responsible For Modified Adjusted Gross Income Medical Assistance Units

Addressing Persistent Medicaid Enrollment and Renewal Challenges as ...

MAGI medical AUs belong to the Health Care Authority and are processed in the Washington Healthplanfinder system. They are assigned to the following HCA Community Service Offices :

181 – MAGI AUs that belong to Region 1 geographical/zip catchment
182 – MAGI AUs that belong to Region 2 geographical/zip catchment
183 – MAGI AUs that belong to Region 3 geographical/zip catchment

ACES users are not be able to screen, initiate a review, add a person, reopen or reinstate MAGI AUs.

Any user with inquiry access in ACES or ACES.online is able to see limited data pertaining to MAGI AUs in ACES Mainframe and in ACES.online.

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