PM 15-04-02: Income (FHP, ACA Adults and Family Planning)

WAG 15-04-02

Determine the amount of monthly nonexempt income using calendar months. Monthly nonexempt income minus allowable deductions is countable monthly income, which is compared to the income standard for the size of the Eligibility Determination Group (EDG).

FHPs, ACA Adult, and the New TextFamily Planning program use Modified Adjusted Gross Income (MAGI) budgeting methodology. See PM 08-03-00 for policy regarding countable income for under MAGI budgeting.

Medical eligibility for persons living in the community is determined in whole dollar amounts only. Drop cents from each amount during the Medical eligibility calculation. This includes dropping cents from:

  • each paycheck for earned income,
  • each payment for unearned income,
  • the average weekly/bi-weekly amount,
  • each spousal support payment paid,
  • the gross income from self-employment after deducting appropriate self-employment expenses, and
  • other allowable income deductions listed in PM 08-03-03.

To determine monthly income, both earned and unearned, for persons who receive a payment once a week or once every 2 weeks, and to determine spousal support payment deductions:

  1. Determine an average weekly/bi-weekly amount for the month.
  2. Multiply this amount by 4.3 if the person receives the payment weekly.
  3. Multiply this amount by 2.15 if the person receives the payment bi-weekly.

The average weekly/bi-weekly amount may vary from month to month.

If a person who is paid weekly receives less than 4 checks during a particular month or a person who is paid once every two weeks receives less than 2 checks during a particular month, use the actual amount received.

NOTE: For medical only applications for FHPs, ACA Adults and New TextFamily Planning, you may convert earned or unearned income that is received weekly, every two weeks, or twice a month to a monthly amount prior to entering income into IES data collection. Document how monthly income was calculated in case notes.

FHP/ACA Adults and Marketplace Differences

Eligibility determinations for FHPs and ACA Adults are based on current monthly income. That is, income is considered for the months in which the income is actually received or anticipated to be received. Income deductions are considered for the months in which the expense is paid or anticipated to be paid. 

In contrast, the Marketplace determines eligibility for financial assistance to buy insurance based on the applicant's projected annual income for the tax year, rather than on current monthly income.

This budgeting difference could result in an applicant who is found ineligible for Medicaid due to excess current monthly income, to also be found ineligible for financial help on the Marketplace based on projected annual income that is under 100% of FPL. To qualify for financial help on the Marketplace, most applicants must have income between 100% and 400% of the FPL.

We must do a second determination of eligibility using projected annual income when:

  • the household income of the applicant using current monthly income results in financial ineligibility for FHPs/ACA Adult, and
  • the applicant is ineligible for help in the Marketplace because projected annual income is under 100% FPL.