Modified Adjusted Gross Income (MAGI) - Children's Medical (N11/N31)

Created on: 
Jul 12 2017

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Who is eligible to receive N11 (MAGI - Children's Medical - Federal) and N31 (MAGI - Children's State) medical?

Children under the age of 19 may be eligible for N11 or N31 medical when they meet the requirements described in Apple Health eligibility manual - WAC 188-505-0210 Washington apple health - Eligibility for children.

For income standards, see Apple Health eligibility manual - WAC 182-505-0100 Washington apple health - Monthly income standards based on the federal poverty level (FPL).

Can a client receive N11 (MAGI - Children's Medical - Federal) or N11 (MAGI - Children's State) medical coverage while incarcerated?

When a client is active or approved under some medical coverage groups while incarcerated, they can still be eligible to receive medical assistance in a suspended status. For more information, see Suspended Medical – State Bill (SB 6430).

Can a child be eligible for N11 (MAGI - Children's Medical - Federal) or N31 (MAGI - Children's State) if the household’s income exceeds the N11/N31 income standards?

Children may be eligible for N11/N31 as a separate Medical Assistance Unit (MAU) when certain conditions exist. For more information, see Apple Health eligibility manual - WAC 182-506-0010 Medical assistance units (MAU) for MAGI-based Washington apple health programs.

Children not eligible to receive N11/N31 medical, may be eligible under another program:

Children who were previously approved for certain medical benefits within the last 12 months may be eligible for continuous eligibility. See Continuous Eligibility for Categorically Needy Children's Medical.

How long is the N11 (MAGI - Children's Medical - Federal) or N31 (MAGI - Children's State) certification period?

The certification period for N11/N31 medical is 12 months. When the child turns 19, the certification ends even if the 12 months are not over. For additional information, see Apple Health eligibility manual – WAC 182-504-0015 Washington apple health - Certification periods for categorically needy programs.

Changes during the certification period that affect eligibility should be processed according to Apple Health eligibility manual – WAC 182-504-0125 Washington apple health - Effect of reported changes.

 

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