N.D. Admin. Code 75-02-02.1-34.1

Current through Supplement No. 395, January, 2025

Section 75-02-02.1-34.1 - MAGI-based methodology

Effective for the benefit month of January 2014, the following MAGI-based methodology will be used in determining income eligibility for medicaid.

1. Income is based on household composition.

2. Monthly income is used prospectively for new applications; annualized income is used for ongoing cases.

3. Current, point in time income is used; however, reasonable expected changes in income must be included.

4. A tax dependent child's income does not count in a taxpayer parent's or caretaker relative's household if the child is not required to file a tax return. The child's needs are included in the taxpayer's household.

a. If the taxpayer parent or taxpayer caretaker relative is in the child's medicaid household, the child's income does not count in the child's household, either.

b. If the taxpayer parent or taxpayer caretaker relative is not in the child's medicaid household, the child's income counts in the child's household.

c. If the child is not required to file a tax return, however, files a return to get a refund of taxes withheld, the child's income is not counted.

d. If the child is required to file a tax return, the child's income is counted in all of the households in which the child is included.

5. If eligibility is determined by using an individual's federal tax return, modified adjusted gross income is as stated in the federal tax return:

a. Plus:

(1) Any foreign earned income excluded from taxes.

(2) Tax-exempt interest.

(3) Tax-exempt social security income,

b. Less:

(1) Scholarships, awards, orfellowship grants used for education purposes and not for living expenses if included in taxable income.

(2) Certain distributions, payments, and student financial assistance for American Indians and Alaska Natives if included in taxable income.

6. When available, the department shall use the most current information to reflect the income elements identified in subsection 5, regardless of whether they were the amounts used for the tax return.

7. If eligibility is determined without using an individual's federal tax return, the department shall determine modified adjusted gross income using internal revenue service rules combined with medicaid and children's health insurance program rules as follows:

a. Add:

(1) Gross wages less pretax deductions;

(2) Gross interest income;

(3) Gross dividend income;

(4) Taxable refunds of state or local income taxes (counted only in the month received);

(5) Gross alimony received;

(6) Net business income or loss from self-employment;

(7) Capital gains or losses, if expected to recur;

(8) Taxable amount of individual retirement account distributions;

(9) Taxable amount of pensions and annuities;

(10) Net rents, royalties, and partnership, S corporation, or trust income;

(11) Net farm income or loss;

(12) Gross unemployment compensation;

(13) Gross social security income;

(14) Gross foreign earned income; and

(15) Other income determined to be reportable by the internal revenue service.

b. Subtract from that sum:

(1) Educator expenses;

(2) Business expenses of reservist, performing artist, and fee-basis government official;

(3) Health savings account deduction;

(4) Moving expenses;

(5) Deductible portion of self-employment tax;

(6) Contributions to self-employed SEP, SIMPLE, and qualified plans;

(7) Self-employed health insurance deduction;

(8) Penalty on early withdrawal of savings;

(9) Alimony paid;

(10) Contributions to an individual retirement account;

(11) Student loan interest deduction;

(12) Tuition and fees;

(13) Domestic production activities deduction;

(14) Scholarships, awards, orfellowship grants used for education purposes and not for living expenses; and

(15) Certain distributions, payments, and student financial assistance for American Indians and Alaska Natives.

8. The following income types are not reported on internal revenue service form 1040 and are not countable income under a MAGI-based methodology:

a. Child support income;

b. Veterans' benefits (aid and attendance, homebound benefits, and reimbursements for unusual medical expenses);

c. Supplemental security income;

d. Temporary assistance for needy families benefits;

e. Proceeds from life insurance, accident insurance, or health insurance;

f. Gifts and loans;

g. Inheritances; and

h. Workers' compensation payments.

9. Instead of itemized disregards and deductions, the department may apply a standard disregard equal to five percent of the federal poverty level as part of the MAGI-based methodology.

N.D. Admin Code 75-02-02.1-34.1

Adopted by Administrative Rules Supplement 2014-353, July 2014, effective January 1, 2014. .

General Authority: NDCC 50-06-16, 50-24.1-04

Law Implemented: NDCC 50-24.1-37; 42 USC 1396 a(e)