Section 405 IAC 2-2.5-2 - Eligibility under MAGIAuthority: IC 12-15-21
Affected: IC 12-15-2; IC 12-15-3
Sec. 2.
(a) The eligibility requirements in this rule only apply to the MAGI group defined in section 1 of this rule. The office shall continue to apply all other eligibility standards as provided in this title to non-MAGI groups.(b) Notwithstanding any other provision in this article, the office shall not apply any asset or resource test or income or expense disregards, except for the five percent (5%) income disregard in subsection (d), for any individuals in the MAGI eligibility group with the highest income standard under which the individual may be determined.(c) Except as provided in subsection (j), an individual's financial eligibility for Medicaid under this section is based on the individual's household income as defined in subsection (d). An individual whose eligibility is being determined under this section will be eligible for Medicaid if the MAGI-based income of the individual's household meets the financial threshold requirements in accordance with federal poverty levels established by the office under this title.(d) Except as provided in subdivision (1), household income is the sum of the MAGI-based income, as defined in section 1 of this rule, of the individual and every individual in the individual's household, minus the amount equivalent to five (5) percentage points of the federal poverty level for the applicable family size as follows: (1) The MAGI-based income for a tax filer will include the income of a claimed child or tax dependent if the child or tax dependent will be required to file a tax return under 26 U.S.C. 6012(a)(1) for the taxable year in which eligibility is being determined.(2) If the child or tax dependent will not be required to file a tax return under 26 U.S.C. 6012(a)(1), the income of the child or tax dependent will not count in the household income for the taxpayer who claims them for the taxable year in which eligibility is being determined.(e) The composition of a household for purposes of household income shall be determined as follows:(1) For an individual who: (A) expects to file a tax return for the taxable year in which an initial determination or renewal of eligibility is being made; and(B) does not expect to be claimed as a tax dependent by another taxpayer; the household consists of the taxpayer and, subject to subsection (f), all persons whom such individual expects to claim as a tax dependent.(2) In the case of an individual who expects to be claimed as a tax dependent by another taxpayer for the taxable year in which an initial determination or renewal of eligibility is being made, the household is the household of the taxpayer claiming such individual as a tax dependent, except that the household must be determined in accordance with subdivision (3) in the case of the following: (A) Individuals other than a spouse or a biological, adopted, or step child who expect to be claimed as a tax dependent by another taxpayer.(B) Individuals under nineteen (19) years of age who expect to be claimed by one (1) parent as a tax dependent and are living with both parents but whose parents do not expect to file a joint tax return.(C) For the purposes of this section, in determining which parent claims an individual under nineteen (19) years of age as a tax dependent, who expect to be claimed as a tax dependent, the following documentation will be used to determine the tax dependent status: (i) A court order or binding separation, divorce, or custody agreement establishing physical custody controls.(ii) If there is no such order or agreement or in the event of a shared custody agreement, the custodial parent is the parent with whom the child spends most nights.(3) In determining the household composition, the household includes an individual who:(A) does not expect to file a federal tax return and does not expect to be claimed as a tax dependent for the taxable year in which an initial determination or renewal of eligibility is being made; or(B) is described in subdivision (2)(A), (2)(B), or (2)(C); the household consists of the individual and, if living with the individual:(i) the individual's spouse;(ii) the individual's natural, adopted, and step children under the age of nineteen (19) years of age; and(iii) in the case of individuals under nineteen (19) years of age, the individual's natural, adopted and step parents and natural, adoptive, and step siblings under nineteen (19) years of age.(4) In the case of a married couple living together, each spouse will be included in the household of the other spouse, regardless of whether they expect to file a joint tax return under 26 U.S.C. 6013, which is hereby incorporated by reference, or whether one (1) spouse expects to be claimed as a tax dependent by the other spouse.(f) The office may require the individual under this section to verify the household size for subsection (e)(1). This verification may include a self-attestation from the individual as to household size. If the individual cannot reasonably establish that another individual is a tax dependent of the taxpayer for the tax year in which Medicaid is sought, the inclusion of such individual in the household of the taxpayer is determined in accordance with subsection (e)(3).(g) Financial eligibility for Medicaid for applicants, and other individuals not receiving Medicaid benefits at the point at which eligibility for Medicaid is being determined, must be based on current monthly household income and family size.(h) Except as provided in subdivision (1), for individuals who have been determined financially eligible for Medicaid using the MAGI-based methods set forth in this section, the office shall base financial eligibility on income based on current household income and family size for the remainder of the current calendar year under subsection (i). Application of the MAGI-based methods will not be applied to Medicaid beneficiaries determined eligible for Medicaid to begin on or before December 31, 2013. Application of the MAGI-based methodologies for individuals under this subsection will not be applied until either: (2) the next regularly scheduled renewal of eligibility for such individual; whichever is later.(i) The office may accept an individual's attestation of projected annual household income and household size for purposes of establishing financial eligibility for Medicaid under this section. The office may require the individual to submit additional documentation to resolve discrepancies, including documentation sufficient to establish a reasonably predictable increase or decrease in future income or family size. Such documentation may include, but is not limited to: (1) a signed contract for employment;(2) a clear history of predictable fluctuations in income or family size; or(3) other clear indicia of future changes in income or family size.(j) In determining annual household income and family size under subsection (g) or (h), the office will include a prorated portion of reasonably predictable future income, to account for a reasonably predictable increase or decrease, or both, in future income.(k) If the household income of an individual determined in accordance with this section results in financial ineligibility for Medicaid and the household income of such individual determined in accordance with 26 CFR 1.36B-1(e) is below one hundred percent (100%) federal poverty level, Medicaid financial eligibility will be determined in accordance with 26 CFR 1.36B-1(e), which is hereby incorporated by reference.Office of the Secretary of Family and Social Services; 405 IAC 2-2.5-2; filed 6/11/2021, 2:35 p.m.: 20210707-IR-405190602FRA