Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 105 - Budgeting
Chapter 1 - Introduction to Budgeting - FCC Programs
Rule 23-105-1.1 - Budgeting Rules for FCC Programs

A. The Affordable Care Act (ACA) requires the use of MAGI-based budgeting rules for determining household size, household composition, household income and need standards which are all defined below. MAGI-based budgeting processes include rules for households that file federal income taxes and rules for households that do not file federal income taxes, referred to as non-filer households.

B. Household or family size is the number of persons counted as members of an individual's household. If one of the household members is pregnant, the pregnant woman is counted as herself plus the number of children she is expected to deliver. Individuals cannot choose who is to be included or excluded from their household for budgeting purposes, even though all household members may not be applying. All household members and their relationship to each other, tax filing status and marital status are considered for budgeting purposes. Married couples living together must always be included in the same household, regardless of the tax filing status of the couple.

C. Household income, as defined in Part 104, Chapter 11, includes every individual included in the household. The only allowable disregard is a five (5) percentage point disregard of the FPL based on household size. The income of children and tax dependents other than a spouse or child who are not required or expected to file a tax return is not included in household income whether or not the individual actually files a tax return, unless a specified exception exists.

D. Need standards that were in effect for FCC covered categories of eligibility prior to the implementation of the ACA must be converted to MAGI-equivalent levels to account for any income disregards in use prior to the ACA. The limits, based on either a state-established threshold or federal poverty levels, are adjusted to account for an average of income disregards in use prior to the ACA and cannot be less than the income levels in use prior to the ACA. Income limits in use for FCC programs effective with the implementation of the ACA are referred to as MAGI-equivalent income standards. The appropriate need standard to use in determining the eligibility of an individual is based on the age of the individual applying, the individual's household size and total household income as determined using MAGI income rules.

E. MAGI need standards are applicable to MAGI-based categories of eligibility for applications approved on and after implementation of the ACA. Ongoing cases will be transitioned to the new MAGI need standards at the time the case is reviewed after implementation of the ACA, unless otherwise mandated by the ACA.

F. Children who lose Medicaid eligibility during the conversion to MAGI whose sole reason for ineligibility is the loss of income disregards allowed prior to the implementation of the ACA will be granted a twelve (12) month protected period of CHIP eligibility. CHIP children losing eligibility due to the loss of income disregards will be referred to the HIX as the ACA affords no equivalent protection for children losing CHIP eligibility.

G. Household composition and determining whose income counts for MAGI based categories of eligibility are determined by using tax filer rules, exceptions to tax filer rules or non-tax filer rules, as appropriate. It is necessary to evaluate each household member individually in order to apply the appropriate household composition rule.