Current through Register Vol. 50, No. 9, September 20, 2024
A. MAGI-based
1. Income shall be calculated in accordance
with
42 CFR §
435.603 and §
457.315.
2. - 29.z.ii. Repealed.
B. Financial eligibility for the MAGI groups
shall be made using income received in the calendar month prior to the month of
application or renewal as an indicator of anticipated income. The taxable gross
income of each member of the MAGI household shall be used. Income eligibility
of the household shall be based on anticipated income and circumstances unless
it is discovered that there are factors that will affect income currently or in
future months.
1. Income eligibility is
determined by prospective income budgeting or actual income budgeting.
a. Prospective income budgeting involves
looking at past income to determine anticipated future income. Income earned in
the calendar month prior to the month of application or renewal which the
applicant/enrollee earned shall be used to determine expected income in the
current and future months.
b.
Actual income budgeting involves looking at income actually received within a
specific month to determine income eligibility for that month. Actual income
shall be used for all retroactive coverage. Actual income or the best estimate
of anticipated actual income shall be used if:
i. the income terminates during the month;
ii. the income begins during the
month; or
iii. the income is
interrupted during the month.
2. The net countable income for the
individuals household shall be compared to the applicable income standard for
the household size to determine eligibility.
a. If the countable income is below the
income standard for the applicable MAGI group, the individual is income
eligible.
b. If the countable
income is above the income standard for the applicable MAGI group, the
individual is income ineligible.
3. - 5.b. Repealed.
C. Federal Poverty Income Guidelines (FPIG).
Eligibility shall be based upon the following guidelines using the federal
poverty income guidelines and adjusted to account for the 5 percent disregard:
1. parents/caretakers, income is less or
equal to 24 percent FPIG;
2.
pregnant women, income is less or equal to 138 percent FPIG;
3. CHAMP (children 0-18), income is less or
equal to 147 percent FPIG;
4.
LaCHIP, income is less or equal to 217 percent FPIG;
5. LaCHIP IV (unborn option), income is less
or equal to 214 percent FPIG;
6.
LaCHIP Affordable Plan, income is less or equal to 255 percent FPIG;
7. Adult Group, income is less than or equal
to 138 percent FPIG; and
8. Take
Charge Plus, income is less than or equal to 138 percent FPIG.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
