Eligibility Online Manual

M1201B Child MAGI

Purpose: This section will assist in determining Medicaid eligibility for children ages 0-18 years.

Current Policy Effective Date: January 1, 2014

Date Last Reviewed: July 14, 2015

Previous Policy: November 1, 2012


1. Applicants Must Meet Basic Eligibility Factors

Refer to Section M600 for a description of all basic eligibility factors.

2. Applicants Must Be Under Age Nineteen

3. Applicants Must Meet Income Requirements

Countable family income must be less than or equal to 154% of FPL for children 0-5 and 133% of FPL for children 6-18. Refer to Medicaid Table 1. Refer to Table 2A to determine if income is countable.

4. Applicants Do Not Have Resource Test

5. Benefits Begin First Day Of The Application Month If Determined Eligible

6. Applicants May Be Eligible For Retroactive Benefits

Applicants may receive retroactive Medicaid benefits if they incurred medical bills during any of the three months prior to application.

Both approved and denied applicants must be reviewed. Reviewer must verify and determine eligibility separately for each retroactive month to determine whether the case would have been eligible if an application had been made.

7. Applicants May Have Eligibility For 12 Continuous Months

The eligibility continues for 12 months from the effective date of eligibility or for 12 months from the last periodic review.

8. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

9. Clients Who Transfer To A New Coverage Group

Clients who turn one under the Newborn program, need to be transitioned to the Child MAGI coverage group, the first day of the next month, following the child’s birthday.

10. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

    • Client does not complete review.

    • Client enters a public institution, excluding the Geriatric Hall at the State Hospital in Evanston.

    • Client dies.

    • Client moves out of state.

    • Client determined no longer eligible.


Defining Group: 42 CFR 435.116

42 CFR 435.904

Social Security Act § 1902(e)(12)

Income: Social Security Act § 1902(a)(10)(A)(i)(VI)

Social Security Act §1902(a)(10)(A)(ii)(IX)

Clarifying Information:

A child is defined as a dependent between birth and 18 years of age who is not an emancipated minor or a minor parent.

Asset Transfer Provisions Do Not Apply.

Children Receiving Medicare Still Qualify.

Worker Responsibilities:

Determining Countable Income

1. Refer to Table 2A for information on countable income.

Determining Retroactive Benefits

1. Determine whether each approved or denied applicant incurred medical bills during any of the three months prior to the date of application.

Closing Cases

1. Send 15-Day closure notice when an adverse action has occurred.