1 MAGI Based Methodologies – Territories

Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
S10T-MAGI Based Methodologies - Territories RU
PRA document
Version 1.0
08/16/2017

Document Number: 176-QSSI-MACPro-R5.1-S10T-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. S10T- MAGI Based Methodologies - Territories Screenshots.............................. 1
1.1
1.2
1.3
1.4

Section A. Household Composition ................................................................. 1
Section B. Household Income – Options 1-5................................................... 2
Section B. Household Income – Options 6-8................................................... 2
Section C. Resource Test and Section D. Additional Information (optional) ... 3

List of Figures
Figure 1: Section A- Household Composition.................................................................. 1
Figure 2: Section B-Options 1-5 ...................................................................................... 2
Figure 3: Section B- Options 6-8 ..................................................................................... 2
Figure 4: Section C and Section D .................................................................................. 3

List of Tables
No table of figures entries found.

S10T-MAGI Based Methodologies - Territories RU PRA document Version
1.0
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08/16/2017

CMS XLC

Section A. Household Composition

1. S10T- MAGI Based Methodologies - Territories
Screenshots
1.1

Section A. Household Composition

Figure 1: Section A- Household Composition

S10T-MAGI Based Methodologies - Territories RU PRA document Version
1.0
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08/16/2017

CMS XLC

1.2

Section B. Household Income – Options 1-5

Section B. Household Income – Options 1-5

Figure 2: Section B-Options 1-5

1.3

Section B. Household Income – Options 6-8

Figure 3: Section B- Options 6-8

S10T-MAGI Based Methodologies - Territories RU PRA document Version
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08/16/2017

CMS XLC

1.4

Section C. Resource Test and Section D. Additional Information (optional)

Section C. Resource Test and Section D. Additional Information
(optional)

Figure 4: Section C and Section D

S10T-MAGI Based Methodologies - Territories RU PRA document Version
1.0
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08/16/2017