2669 MAGI Budgeting | Medicaid
Georgia Division of Family and Children Services |
||||
Policy Title: |
MAGI Budgeting |
|||
Effective Date: |
October 2025 |
|||
Chapter: |
2600 |
Policy Number: |
2669 |
|
Previous MT Number(s): |
MT 60 |
Updated or Reviewed in MT: |
MT 77 |
Requirements
Modified Adjusted Gross Income (MAGI) methodologies are used to budget all applications and periodic renewals of financial eligibility for Parent/Caretaker with Child(ren), Children Under 19 Years of Age, Pregnant Women Medicaid, Pathways, PeachCare for Kids® (PCK) and Planning for Healthy Babies® (P4HB).
Basic Considerations
The MAGI budget includes the taxable income of all individuals in the budget group (BG).
Do not include the taxable income of a BG tax dependent child if not required to file a tax return. This amount changes yearly and is determined by the Internal Revenue Service (IRS).
A percentage of the Federal Poverty Level (FPL) is used to determine financial eligibility for Family Medicaid MAGI classes of assistance (COAs) based on the BG’s net taxable income
Net taxable income is the BG’s income after deducting the following:
-
cost of doing business for self-employed or farming/fishing individuals
-
Before-Tax deductions
-
1040 deductions
-
MAGI 5% FPL deduction
A percentage of the Federal Poverty Level (FPL) is used to determine MAGI financial eligibility based on the BG’s net countable income.
Procedures
Follow the steps below to determine eligibility for MAGI COAs.
Step 1 |
For self-employed or farming/fishing individuals, deduct all allowable IRS deductions. Refer to Section 2415 - Self-Employment. |
||
Step 2 |
Deduct any before-tax deductions of taxable income. |
||
Step 3 |
Deduct any 1040 deductions of taxable income. |
||
Step 4 |
Subtract from the net taxable income 5% of the 100% FPL for the budget group size. Please refer to Appendix A2 - Family Medicaid Financial Limits TOC for the deduction amounts for each budget group size. |
||
Step 5 |
Select the appropriate income limit; either the Parent/Caretaker with Child(ren) limit, or the appropriate Pregnant Women or Children Under 19 Years of Age net taxable limit using the criteria below. Refer to Appendix A2 - Family Medicaid Financial Limits TOC.
|
||
Step 6 |
Compare the net taxable income amount to the appropriate income limit for the BG size
|
If the net taxable income exceeds the appropriate income level for the BG size, the AU members are ineligible for Medicaid. If ineligible for Parent/Caretaker with Child(ren), complete a CMD to Children Under 19 Years of Age Medicaid coverage; refer the adults to GA Access. If ineligible for Children Under 19 Years of Age coverage, complete a CMD to PeachCare for Kids® (PCK). If ineligible for PCK coverage, refer ineligible children to GA Access.
Prior to referring adult women to GA Access who are ineligible for Parent/Caretaker with Child(ren), CMD to P4HB if they confirm they want P4HB. If ineligible for P4HB, then continue with referral to GA Access. Because the Children Under 19 Years of Age income limits vary based on the age of the child, it is possible that a child(ren) may be eligible for Medical Assistance while another child(ren) in the same BG may be ineligible. Complete a CMD as indicated above for an ineligible child(ren) in a budget group. |