CMS-10398 #17 MAGI-Based Income Methodologies

CHIP Eligibility
OMB Control Number: 0938‐1148

Separate Child Health Insurance Program
MAGI-Based Income Methodologies

CS15

2102(b)(1)(B)(v) of the SSA and 42 CFR 457.315

The CHIP Agency will apply Modified Adjusted Gross Income methodologies for all separate CHIP covered groups, as described
below, and consistent with 42 CFR 457.315 and 435.603(b) through (i).
In the case of determining ongoing eligibility for enrollees determined eligible for CHIP on or before December 31, 2013, MAGIbased income methodologies will not be applied until March 31, 2014 or the next regularly-scheduled renewal of eligibility,
whichever is later.
If the state covers pregnant women, in determining family size for the eligibility determination of a pregnant woman, she is counted
as herself plus each of the children she is expected to deliver.
In determining family size for the eligibility determination of the other individuals in a household that includes a pregnant woman:
The pregnant woman is counted just as herself.
The pregnant woman is counted just as herself, plus one.
The pregnant woman is counted as herself, plus the number of children she is expected to deliver.
Financial eligibility is determined consistent with the following provisions:
When determining eligibility for new applicants, financial eligibility is based on current monthly income and family size.
When determining eligibility for current beneficiaries, financial eligibility is based on:
Current monthly household income and family size.
Projected annual household income for the remaining months of the current calendar year and family size.
In determining current monthly or projected annual household income, the state will use reasonable methods to:
Include a prorated portion of the reasonably predictable increase in future income and/or family size.
Account for a reasonably predictable decrease in future income and/or family size.
Except as provided at 42 CFR 457.315 and 435.603(d)(2) through (d)(4), household income is the sum of the MAGI-based income of
every individual included in the individual's household.
Household income includes actually available cash support, exceeding nominal amounts, provided
by the person claiming an individual described at §435.603(f)(2)(i) as a tax dependent.
The CHIP Agency certifies that it has submitted and received approval for the conversion for all separate CHIP covered group
income standards to MAGI-equivalent standards.
An attachment is submitted.

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CHIP Eligibility
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