Modified Adjusted Gross Income (MAGI)
DSHS Home Page
 
Search     for:
DSHS Home    Acronyms    Alerts    Screens    WAC Number Index    WCCC

Modified Adjusted Gross Income (MAGI)


Revised January 22, 2014



Modified Adjusted Gross Income (MAGI) MEDICAL

 

What is Modified Adjusted Gross Income (MAGI)?

 

What is MAGI-based medical?

 

How do clients apply for MAGI medical?

 

Who is responsible for MAGI AUs?

 

What are the MAGI medical groups?

 

What happens when changes are reported Washington Healthplanfinder?

 

Retroactive MAGI Medical

 

MAGI Program Codes

 


 

What is Modified Adjusted Gross Income (MAGI)?

 

·        MAGI is a methodology used to determine household composition and calculate the countable income when determining eligibility for Medicaid/CHIP.

 

·        The MAGI income methodology is based on the IRS tax filing status of the applicant.

 

What is MAGI-based medical?

 

·        MAGI-based medical refers to Medicaid/CHIP coverage for individuals who are relatable to Medicaid/CHIP by being a child, pregnant, custodial parent/caretaker, or an eligible adult under age 65 and whose income is below the Federal Poverty Level (FPL) threshold for the program using the MAGI income methodology.

 

How do clients apply for MAGI medical?

 

·        Individuals apply for MAGI medical through a Health Benefit Exchange called Washington Healthplanfinder – an online portal that processes the applications.

 

Who is responsible for MAGI medical AUs?

 

·        MAGI medical AUs belong to the Health Care Authority (HCA) and processed in the Washington Healthplanfinder system, They are be assigned to the following HCA CSOs:

 

o   181 - MAGI AUs that belong to Region 1 geographical/zip catchment

 

o   182 - MAGI AUs that belong to Region 2 geographical/zip catchment

 

o   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. However 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.  

 

What are the MAGI medical groups?

 

·        The following is a list of the MAGI medical groups:

 

o   N01 - Parent/Caretaker

o   N02 - Parent/Caretaker Transitional Medicaid

o   N03 - Pregnant Woman's Medicaid

o   N05 - New Adult Medical Program (effective 01/01/2014)

o   N23 - State Funded Pregnant Woman’s

o   N10 - Newborn Medicaid

o   N11 - Children's Medicaid (Federally Qualified)

o   N31 - State Funded Children's Medical (Non-Qualified/Non-Federally Qualified)

o   N13 - CHIP (Federally Qualified)

o   N33 - State Funded CHIP (Non-Qualified/Non-Federally Qualified)

o   N21 - Alien Emergency Medical Parent/Caretaker

o   N25 - New Adult Alien Emergency Medical (effective 01/01/2014)

 

What happens when changes are reported in Washington Healthplanfinder?

 

·        When changes are reported by an individual in Washington Healthplanfinder for MAGI AUs 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:

 

o   AUTO overlaying some of the ACES data with the Healthplanfinder data.

 

o   Displaying some of the MAGI data in aces.online for comparison against existing ACES data.

 

o   Generating a Barcode Tickle.

 

o   Invoking a call to the Eligibility Service for a benefit recalculation.


NOTE:

When an address change is made in ACES to a Cash, Basic Food or Classic Medical AU and there is a related MAGI AU, the change is communicated back to Washington Healthplanfinder by a manual process. Reports will be generated for HCA users to manually make demographic changes in their system to keep data in sync between the two systems.



 

Retroactive MAGI Medical

 

When can retro medical be requested for MAGI AUs?

 

How is retro medical determined in ACES for MAGI AUs?

 

What reason codes are allowed to deny retro benefit months?

 

How do I initiate retro medical?

 

How do I finalize the retro medical?

 


 

When can retro medical be requested for MAGI AUs?

 

·        Retro medical can be approved for MAGI AUs (N-Track) up to three months prior to an Application Date of October 2013, except for N05 and N25 AUs.

 

·        Retro medical on N05 and N25 AUs can only be approved back to January 2014.

 

How is retro medical determined in ACES for MAGI AUs?

 

·        Retro medical eligibility for MAGI medical must be determined offline by the user before finalizing the retro medical. ACES performs no eligibility test.

 

·        Users have specific reason codes available to deny retro medical on the RMCO screen for months the client is not eligible.  

 

·        MAGI AUs will be approved for benefit months with no reason code entered.

 

·        No letters generate for MAGI AUs and ACES will not modify a MAGI AU in any way, other than to set the AU and client status and financial responsibility code.

 

o   HCA eligibility staff must manually generate the necessary approval and denial letters from the Healthplanfinder system as needed.

 

What reason codes are allowed to deny retro benefit months?

 

·        When any particular month in the retro period needs to be denied, enter one of the following reason codes on the RMCO screen to deny that particular month:

 

o   201 – Living Arrangement

o   202 – Citizenship/Alien Status

o   210 – Failed Residency Requirement

o   220 – Failed Age Requirement

o   301 – Exceeds Income Standard

o   503 – No evidence from ACPT med src

o   504 – No sufficient info

o   520 – Program ended due to fed law chg

o   528 – ER Incomplete

o   550 – Voluntary Withdrawal

o   551 – Whereabouts Unknown

o   552 – Failed to Provide Verification

o   559 – Client discontinued name clearance

o   561 – AMEN denial of screened AU

o   566 – No coop elig process

o   577 – Missed application deadline

o   587 – Already Eligible

o   588 – Cannot receive duplicate

o   599 – Other


NOTE:

Denial codes must be entered in the initial entry on the RMCO screen when in Option W – Retro Medicaid Copy.        


How do I initiate retro medical?

 

1.     On the AMEN  screen:

 

o   Enter Option W – Retro Medicaid Copy

 

o   Enter the AUID in the AU ID field.

 

o   Press <Transmit> and the Retroactive Medicaid Copy - RMCO screen displays.

 

2.     On the RMCO screen:

 

o   If any month needs to be denied, enter the appropriate denial code in the AU RSN CODE field after benefit month.

 

o   Enter a [Y] in the Continue field.  Press <Transmit> and the AMEN screen displays.

 

How do I finalize the retro medical?

 

1.     On the AMEN screen:

 

o   Select Option X – Finalize RETRO Medicaid.

 

o   Press <Transmit> and the Finalize Retroactive Medicaid - FRME screen displays.

 

o   Press <Transmit> and the ELIG screen displays. 

 

o   Confirm eligibility for all benefit months and finalize.  Press <Transmit>.



 

Modified Adjusted Gross Income (MAGI) MEDICAL PROGRAM CODES

 

Program Codes

MAGI Medical Coverage Group Definition

N01

Parent/Caretaker

N02

Parent/Caretaker Transitional

N03

Pregnancy – Federal Funded

N05

New Adult

N10

Newborn

N11

Children’s Medical – Federal Funded

N13

Children’s Health Insurance Program (CHIP)

Federal Funded

N21

Parent/Caretaker Alien Emergency Medicaid (AEM)

N23

Pregnancy – State Funded

N25

New Adult Alien Emergency Medicaid (AEM)

N31

Children’s Medical – State Funded

(Non-Qualified/Non-Federally Qualified)

N33

Children’s Health Insurance Program (CHIP) – State Funded

(Non-Qualified/Non-Federally Qualified)

 

Modification Date: January 22, 2014