MR #13.21: MAGI Equivalent Income Standards for Family Health Plans and ACA Adults

Helping Families. Supporting Communities. Empowering Individuals.

Illinois Department of Healthcare and Family ServicesIllinois Department of Human Services

10/03/13

Summary:

  • The Affordable Care Act (ACA) requires states to convert income standards to MAGI equivalent standards. The converted standards take into account that some income disregards will no longer apply under the Modified Adjusted Gross Income (MAGI) budgeting methodology.
  • Additionally, standards must be based on federal poverty levels that were in effect in March 2010 and that have been converted to MAGI equivalent standards. HFS can change these standards for pregnant women in January 2014, but cannot change them for children until October 2019. The ACA allowed states with budget problems to reduce income standards but only for parents and caretaker relatives.
  • This release provides the MAGI income standards for Family Health Plans (FHP) and the new ACA Adult group for 2013.
  • The MAGI income standards will be used for FHPs and ACA Adults for initial applications received and processed in the Integrated Eligibility System (IES) on or after October 1, 2013.
  • From October 2013 until February 2014, income standards for MAGI affected cases will be different in ACM than what is used in IES.
    • Pre-MAGI conversion standards will remain in effect for active FHP cases until the Automated Case Management (ACM) system is retired in February 2014.
    • After ACM is retired, the same standards will be used in IES for applications and case maintenance starting with changes, redeterminations and renewals processed effective April 2014 and later.
    • Applications taken in AIS before 10/01/13 are not subject to the MAGI equivalent standards; applications received 10/01/13 and later for FHPs and ACA Adults are to be registered and processed in IES only.
  • There are no changes in standards used for the CountyCare waiver program at this time.
  • Different MAGI standards for pregnant women will be announced later for January 2014.
  • Updates the Program Standards Desk Aid.

The Affordable Care Act (ACA) requires states to convert income standards to MAGI equivalent standards to take into account that certain income disregards, such as the $90 employment deduction and the child care disregard, will no longer apply under MAGI budgeting methodology.

Additionally, ACA requires that FPL standards that were in effect in March 2010, when ACA was signed into law, be converted to MAGI equivalent standards. Converting income standards that were in place in March 2010 to MAGI equivalent standards assures that the maintenance of effort (MOE) requirements of the ACA are met. The MOE requirement expires for the income standard for adults on January 1, 2014. The MOE requirement for children does not expire until October 1, 2019.

The converted MAGI equivalent income standards will not be updated in the budgeting examples contained in WAG Chapter 15 until the MAGI Budgeting manual release is posted prior to IES Phase 2 implementation. Until then please refer to the policy memo, Modified Adjusted Gross Income (MAGI) Budgeting for Medical, dated 9/26/13.

  • Note: Income standards for Family Assist and Family Health Spenddown are not changed.

MAGI Income Standards

A standard 5% FPL income reduction or disregard applies to the highest Medicaid or Children's Health Insurance Program (CHIP) program for which a person can be eligible before being referred to the Federally Facilitated Marketplace. Those programs are:

  • FamilyCare (Medicaid for parents & caretaker relatives of children under age 18),
  • All Kids Assist (Medicaid for children),
  • All Kids Premium Level 2 (CHIP),
  • Moms & Babies (Medicaid for pregnant women & deemed newborns), and
  • ACA Adults (Medicaid for adults age 19-64).

The updated income standards for MAGI groups are:

Program and MAGI Equivalent FPL Links to Amounts
  • All Kids Assist: 147% of the FPL (142% plus 5%)
  • All Kids Share: 148% to 157% of the FPL
  • All Kids Premium Level 1: 158% to 209% of the FPL
WAG 25-03-02(2)
  • All Kids Premium Level 2: 210% to 318% of the FPL (313% plus 5%)
WAG 25-03-02(4)
  • FamilyCare: 138% of the FPL (133% plus 5%)
  • ACA Adults: 138% of the FPL (133% plus 5%)
  • Moms & Babies: 209% of the FPL (204% plus 5%)
WAG 25-03-02(2)
Medicaid Presumptive Eligibility: 209% of the FPL (204% plus 5%) WAG 06-10-05

MAGI Standards in IES and ACM

The MAGI income standards will be used for FHPs and ACA Adults for new applications received and processed in the Integrated Eligibility System (IES) on or after October 1, 2013.

Pre-MAGI standards will remain in effect for active FHP cases until the Automated Case Management (ACM) system is retired in February 2014. Pre-MAGI standards remain in place for CountyCare. Separate policy will be issued at a later date concerning changing CountyCare standards to MAGI.

After ACM is retired, the MAGI standards will be used in IES starting with changes, redeterminations and renewals processed effective April 2014 and later. As a reminder, Medical program income standards are based on federal poverty levels (FPLs) that are updated annually. As in the past, a manual release will be posted to inform staff about changes to the income standards based on 2014 FPLs.

MAGI Standards Are Not Programmed in AIS

Applications taken in AIS before 10/01/13 are not subject to the MAGI equivalent standards. Those applications must continue to be processed in AIS.

Applications received 10/01/13 and later for FHPs and ACA Adults are to be registered and processed in IES only. Do not register or process Family Health Plans applications with an application date of 10/01/13 or later in AIS.

Program Standards Desk Aid

The Program Standards Desk Aid in WAG 25-03-02 (pdf) has been updated with the new income standards.

MANUAL REVISIONS

[signed copy on file]

Michelle R. B. Saddler 

Secretary, Illinois Department of Human Services 

Julie Hamos 

Director, Illinois Department of Healthcare and Family Services