Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 105 - Budgeting › Chapter 1 - Introduction to Budgeting - FCC Programs › Rule 23-105-1.1 - Budgeting Rules for FCC Programs

Current through June 25, 2024
A. The Affordable
				Care Act (ACA) requires the use of MAGI-based budgeting rules for determining
				household size, household composition, household income and need standards
				which are all defined below. MAGI-based budgeting processes include rules for
				households that file federal income taxes and rules for households that do not
				file federal income taxes, referred to as non-filer households.
B. Household or family size is the number of
				persons counted as members of an individual's household. If one of the
				household members is pregnant, the pregnant woman is counted as herself plus
				the number of children she is expected to deliver. Individuals cannot choose
				who is to be included or excluded from their household for budgeting purposes,
				even though all household members may not be applying. All household members
				and their relationship to each other, tax filing status and marital status are
				considered for budgeting purposes. Married couples living together must always
				be included in the same household, regardless of the tax filing status of the
				couple.
C. Household income, as
				defined in Part 104, Chapter 11, includes every individual included in the
				household. The only allowable disregard is a five (5) percentage point
				disregard of the FPL based on household size. The income of children and tax
				dependents other than a spouse or child who are not required or expected to
				file a tax return is not included in household income whether or not the
				individual actually files a tax return, unless a specified exception
				exists.
D. Need standards that were
				in effect for FCC covered categories of eligibility prior to the implementation
				of the ACA must be converted to MAGI-equivalent levels to account for any
				income disregards in use prior to the ACA. The limits, based on either a
				state-established threshold or federal poverty levels, are adjusted to account
				for an average of income disregards in use prior to the ACA and cannot be less
				than the income levels in use prior to the ACA. Income limits in use for FCC
				programs effective with the implementation of the ACA are referred to as
				MAGI-equivalent income standards. The appropriate need standard to use in
				determining the eligibility of an individual is based on the age of the
				individual applying, the individual's household size and total household income
				as determined using MAGI income rules.
E. MAGI need standards are applicable to
				MAGI-based categories of eligibility for applications approved on and after
				implementation of the ACA. Ongoing cases will be transitioned to the new MAGI
				need standards at the time the case is reviewed after implementation of the
				ACA, unless otherwise mandated by the ACA.
F. Children who lose Medicaid eligibility
				during the conversion to MAGI whose sole reason for ineligibility is the loss
				of income disregards allowed prior to the implementation of the ACA will be
				granted a twelve (12) month protected period of CHIP eligibility. CHIP children
				losing eligibility due to the loss of income disregards will be referred to the
				HIX as the ACA affords no equivalent protection for children losing CHIP
				eligibility.
G. Household
				composition and determining whose income counts for MAGI based categories of
				eligibility are determined by using tax filer rules, exceptions to tax filer
				rules or non-tax filer rules, as appropriate. It is necessary to evaluate each
				household member individually in order to apply the appropriate household
				composition rule.
42 CFR§435.603
				  (Rev. 2012)