DAR File No. 38317

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-304-5

MAGI-Based Coverage Groups

Notice of Proposed Rule

(Amendment)

DAR File No.: 38317
Filed: 02/27/2014 12:15:49 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to clarify the household composition for non-tax filers using Modified Adjusted Gross Income (MAGI) methodology, and to clarify when cash support payments are counted as income.

Summary of the rule or change:

This amendment clarifies that a dependent child or an eligible child's sibling who is age 19 or 20 and a full-time student is also included in the household size of those individuals whose household composition is based upon non-tax filer MAGI rules. This change also clarifies criteria for when a cash support payment is to be counted as income.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Pub. L. No. 111-148
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this change only clarifies household composition using MAGI-based rules.

local governments:

There is no impact to local governments because they neither fund Medicaid services nor determine Medicaid eligibility.

small businesses:

There is no impact to small businesses because this change only clarifies household composition using MAGI-based rules.

persons other than small businesses, businesses, or local governmental entities:

There is no impact to Medicaid providers and to Medicaid recipients because this change only clarifies household composition using MAGI-based rules.

Compliance costs for affected persons:

There is no impact to a single Medicaid provider or to a Medicaid recipient because this change only clarifies household composition using MAGI-based rules.

Comments by the department head on the fiscal impact the rule may have on businesses:

This will have no impact on business as our analysis does not predict any significant change in enrollment as result of this rule.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

04/14/2014

This rule may become effective on:

04/21/2014

Authorized by:

David Patton, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-304. Income and Budgeting.

R414-304-5. MAGI-Based Coverage Groups.

(1) The Department adopts and incorporates by reference 42 CFR 435.603, October 1, 2012 ed., 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 eligibility agency elects the option[shall count children who are under 19 years of age and are full-time students in the household size of individuals whose household size is determined under the non-tax filer rules found] in 42 CFR 435.603(f)(3) (iv)(B).

(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:[from a tax filer who claims the individual as a tax dependent when that dependent is not the spouse or child of the tax filer, but only the amount that exceeds a minimal amount set by the Department.]

(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.

 

KEY: financial disclosures, income, budgeting

Date of Enactment or Last Substantive Amendment: [January 1, ]2014

Notice of Continuation: January 23, 2013

Authorizing, and Implemented or Interpreted Law: 26-18-3