Modified Adjusted Gross Income (MAGI) Coverage for Infants and Children under

Modified Adjusted Gross Income (MAGI) Coverage for Infants and Children under Age Nineteen (19) A. Infants up to age one (1) are covered if household income does not exceed one hundred eighty- five percent (185%) of the federal poverty level (FPL) converted to a Modified Adjusted Gross Income (MAGI) equivalent limit of one hundred ninety-four percent (194%) FPL. 1. An infant born to a Medicaid-eligible mother is deemed to be eligible from birth until the child’s first (1st) birthday, i.e., until the end of the month in which the child was born. 2. The infant’s Medicaid eligibility is approved upon notification from the birthing hospital, or through a claim’s driven process or by worker intervention. No separate application is required. 3. If an infant is not born to a Medicaid-eligible mother or if the birth was not covered by Medicaid, a separate application is required to obtain Medicaid eligibility for the infant. 4. The child’s continued eligibility is reviewed prior to the child’s first birthday to determine if the child can be transitioned to another age-appropriate category for Medicaid or the Children’s Health Insurance Program (CHIP). B. Children age one (1) to age six (6) are covered if household income does not exceed one hundred thirty-three percent (133%) of the federal poverty level converted to a MAGI- equivalent limit of one hundred forty-three percent (143%) of the FPL. The child’s continued eligibility is reviewed prior to the child’s sixth (6th) birthday to determine if the child can be transitioned to another age-appropriate category for Medicaid or CHIP. C. Children age six (6) to age nineteen (19) are covered if household income does not exceed the following limits: 1. One hundred percent (100%) of the federal poverty level converted to a MAGI-equivalent limit of one hundred seven percent (107%) of the FPL. There is no five percent (5%) disregard permitted in this category. 2. If household income exceeds one hundred seven percent (107%) FPL but does not exceed one hundred thirty-three percent (133%) of the FPL, the child is placed in a category referred to as a “quasi-CHIP” category since prior to the Affordable Care Act (ACA) the Medicaid limit for a child age six (6) to age nineteen (19) was at one hundred percent (100%) of the FPL. After the ACA was implemented, children in MAGI households with income between one hundred percent (100%) of the FPL and one hundred thirty-three percent (133%) of the FPL were transitioned from CHIP to Medicaid. There is no MAGI- equivalent limit for this category since the ACA set the maximum Medicaid limit at one hundred thirty-three percent (133%) of the FPL, but a disregard of five (5) percentage points of the federal poverty level is allowed based on household size. 3. If a child has no other creditable coverage and household income exceeds one hundred thirty-three percent (133%) of the FPL, the child is reviewed for eligibility in the CHIP.