Ohio Admin. Code 5160:1-4-01 - MAGI-based medicaid: household composition and income
(A)
This rule d escribes household composition and income
calculations under
42 C.F.R.
435.603 (as in effect October 1, 2020) when
determining an individual's eligibility for modified adjusted gross income
(MAGI) based medical assistance. This rule does not apply to determinations for
categories of medical assistance on the basis of age, blindness, or disability,
or which only cover an individual's medicare premium or
cost-sharing.
(B)
Definition. "Person" for the purpose of this rule,
means someone in the family or household of an individual applying for or
receiving medical assistance.
(C)
Determining
household composition and family size.
(1)
For the tax year
in which the eligibility determination is being made, household composition and
family size are determined for each individual as follows:
(a)
If an individual
expects to file a federal income tax return and does not expect to be claimed
as a tax dependent, the household composition is the individual, the
individual's spouse if they live together, and all persons whom the individual
expects to claim as a tax dependent as determined under
42 C.F.R.
435.603(f)(1) (as in effect
October 1, 2020).
(b)
If an individual expects to be claimed as a tax
dependent, the household composition is the taxpayer, the taxpayer's spouse if
they live together, the individual, and all other persons whom the taxpayer
expects to claim as a tax dependent as determined under
42 C.F.R.
435.603(f)(2) (as in effect
October 1, 2020), unless the individual meets one of the following
exceptions:
(i)
The individual is a tax dependent of someone other than a
spouse or parent.
(ii)
The individual is a child under the age of nineteen
living with both parents who do not expect to file taxes
jointly.
(iii)
The individual is a child under the age of nineteen who
expects to be claimed as a tax dependent by a non-custodial
parent.
(c)
If an individual does not expect to file a federal
income tax return or to be claimed as a tax dependent, or it is unclear if the
individual will be claimed as a tax dependent, the household composition is
determined under
42 C.F.R.
435.603(f)(3) (as in effect
October 1, 2020) as follows:
(i)
If the non-filer is an adult, the household includes
the individual, the individual's spouse if living together, and the
individual's children under the age of nineteen.
(ii)
If the non-filer
is a child under the age of nineteen, the household includes the individual,
the individual's parents if living with the individual, and the individual's
siblings under the age of nineteen if living with the individual.
(a)
If the individual
(non-filer child) is married, the spouse of the individual is also included in
the household.
(b)
If the individual (non-filer child) has children, the
individual's children are also included in the household.
(2)
When determining the family size of a household
containing at least one pregnant woman, each pregnant woman is counted as
herself plus:
(a)
One; or
(b)
The number of
indicated fetuses. The pregnant woman is to provide a statement from a doctor
or nurse verifying the pregnancy, including the expected date of confinement
and the number of unborn fetuses (if greater than one), if the increase in
family size makes her income-eligible for medical assistance.
(3)
When
determining the household of a married couple who live together, each spouse
will always be included in the other spouse's household, regardless of tax
filing status and regardless of whether either spouse is claimed as a tax
dependent.
(4)
When determining the household of a natural, adoptive,
or step-parent and a child who live together, the parent will always be
included in the child's household, regardless of tax filing status and
regardless of whether the child is claimed as a tax dependent.
(D)
Determining household income.
(1)
MAGI-based income
is determined in accordance with
42 C.F.R.
435.603 (as in effect October 1, 2020)
for:
(a)
The
individual; and
(b)
Each person in the individual's
household.
(2)
The individual's household income is the sum of the
individual's MAGI-based income plus the MAGI-based income of each person in the
individual's household, excluding only the income from the following
individuals who are not expected to be required to file a tax return under
section 6012(a)(1) of the Internal Revenue Code (as in effect October 1, 2020)
for the taxable year in which eligibility is being determined for medical
assistance, whether or not the individual files a tax return:
(a)
A child included
in the household of his or her natural, adoptive, or stepparent;
or
(b)
A tax dependent who meets the definition of a
qualifying child or qualifying relative under
26 U.S.C. 152
(as in effect October 1, 2020).
(3)
Reasonably
predictable changes (RPC) methodology. To account for a reasonably predictable
increase or decrease in future income, such as recurring seasonal or temporary
employment, the projected income is to be prorated equally over a twelve-month
period, in accordance with
42 C.F.R.
435.603(h)(3) (as in effect
October 1, 2020). A reasonably predictable increase or decrease in income is to
be verified by a signed employment contract, a history of predictable
fluctuations in income, or other clear indication of the future income change.
If verification of the future change is not available, the individual's
self-attestation may be used.
(4)
Qualified lottery
winnings and qualified lump-sum income, in the amount of eighty thousand
dollars or more, which are received in a single payment on or after January 1,
2018, are counted as income in the month received and over a period up to one
hundred twenty months under the Bipartisan Budget Act (BBA) of 2018 (
Pub.
L. No. 115-97 ). The total winnings are divided
into equal installments over each month as described:
(a)
Lottery winnings
up to the amount of seventy-nine thousand nine hundred ninety-nine dollars and
ninety-nine cents are only counted in the month received.
(b)
Lottery winnings
between the amounts of eighty thousand dollars and eighty-nine thousand nine
hundred ninety-nine dollars and ninety-nine cents are counted equally over a
two-month period.
(c)
Lottery winnings between the amounts of ninety thousand
dollars and ninety-nine thousand nine hundred ninety-nine dollars and
ninety-nine cents are counted equally over a three-month
period.
(d)
For each additional ten thousand dollars received in
lottery winnings, above the amount of ninety-nine thousand nine hundred
ninety-nine dollars and ninety-nine cents, add one month to the countable time
period, up to a maximum of one hundred twenty months, and equally count the
winnings in each month.
(5)
Nominal payments
to a parent mentor who is trained to assist families with children who do not
have health insurance coverage and who is working with a grantee organization
under section 2113 of the Social Security Act (as in effect October 1, 2020),
are excluded as income under the Helping Ensure Access for Little ones,
Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable (HEALTHY KIDS)
Act (
Pub.
L. No. 115-120 ).
(6)
Alimony
payments.
(a)
Alimony payments received as a result of a new divorce or separation agreement
finalized after December 31, 2018, are not considered income to the recipient
for MAGI budgeting under the Tax Cuts and Jobs Act (
Pub.
L. No. 115-97 ).
(b)
Alimony payments
received as a result of a divorce or separation agreement modified after
December 31, 2018, are not considered income to the recipient for MAGI
budgeting only if the modification was for the purpose of the Tax Cuts and Jobs
Act (
Pub.
L. No. 115-97 ).
(7)
Student loan
debt discharged due to the death or permanent and total disability of the
student is not included as income for MAGI budgeting for tax years 2018 through
2025 under the Tax Cuts and Jobs Act (
Pub.
L. No. 115-97 ).
(8)
The following
deductions are not allowable for MAGI budgeting under the Tax Cuts and Jobs Act
(
Pub.
L. No. 115-97 ):
(a)
Moving expenses
for tax years 2018 to 2025, except for specified active duty
military.
(b)
Alimony paid under a new divorce or separation
agreement finalized after December 31, 2018.
(c)
Alimony paid
under a divorce or separation agreement modified after December 31, 2018, if
the modification was for the purpose of the Tax Cuts and Jobs
Act.
(d)
Tuition and fees for qualified education expenses for
postsecondary education. Scholarships, awards, or fellowship grants used for
education purposes and not for living expenses are still excluded as income as
described in
42 C.F.R.
435.603(e)(2) (as in effect
October 1, 2020).
(9)
Before comparing
an individual's household income to the highest income standard under which the
individual may be determined eligible using MAG-Ibased methodologies, deduct a
dollar amount equal to five per cent of the federal poverty level (FPL) for the
individual's family size.
Replaces: 5160:1-4-01
Notes
Promulgated Under: 111.15
Statutory Authority: 5162.03, 5163.02
Rule Amplifies: 5162.03, 5163.02
Prior Effective Dates: 10/01/2013, 01/01/2016, 08/01/2016
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