R414-304-5. MAGI-Based Coverage Groups

  (1) The Department adopts and incorporates by reference 42 CFR 435.603 (October 1, 2015), which applies to the methodology of determining household composition and income using the Modified Adjusted Gross Income (MAGI)-based methodology.

  (a) The eligibility agency shall count in the household size, the number of unborn children that a pregnant household member expects to deliver.

  (b) The Department elects the option in 42 CFR 435.603(f)(3)(iv)(B).

  (c) The eligibility agency will treat separated spouses, who are not living together, as separate households.

  (2) The eligibility agency may not count as income any payments from sources that federal law specifically prohibits from being counted as income to determine eligibility for federally-funded programs.

  (3) The eligibility agency may not count as income any payments that an individual receives pursuant to the Individual Indian Money Account Litigation Settlement under the Claims Resettlement Act of 2010, Pub. L. No. 111 291, 124 Stat. 3064.

  (4) The eligibility agency shall count as income cash support received by an individual when:

  (a) it is received from the tax filer who claims a tax exemption for the individual;

  (b) the individual is not a spouse or child of the tax filer; and

  (c) the cash support exceeds a nominal amount set by the Department.

  (5) To determine eligibility for MAGI-based coverage groups, the eligibility agency deducts an amount equal to 5% of the federal poverty guideline for the applicable household size from the MAGI-based household income determined for the individual. This deduction is allowed only to determine eligibility for the eligibility group with the highest income standard for which the individual may qualify.