Section 210-RICR-30-00-5.4 - MAGI Household ConstructionA. The principal factor for determining MAGI-based eligibility is tax filing status and household composition and size, based on the rules for household construction. 1. General rules of household construction - For the purposes of calculating MAGI, a household consists of an applicant and the people the applicant claims as a deduction for a personal exemption when filing federal income taxes. Under IRS rules, the taxpayer may claim a personal exemption deduction for him/herself, a spouse, and tax dependents. Non-family members may be included as tax dependents under certain circumstances and are treated as part of the tax household accordingly.2. Special Medicaid rules of household construction - The following rules for constructing a household are applied when making MAGI-based Medicaid eligibility determinations: a. "Relationship-based" rules are used when an applicant is neither filing taxes nor being claimed as a tax dependent, and under the exceptions outlined in § 5.5 of this Part.b. Medicaid household rules are "person specific" within a family. Therefore, a Medicaid household must be constructed for each person within a family.c. For married couples living together, each spouse must be included in the household of the other spouse, regardless of whether they expect to file a joint federal tax return or whether one (1) spouse expects to be claimed as a tax dependent by the other spouse.d. If a pregnant person is applying for coverage or is part of another applicant's household, the household size must be adjusted to reflect the number of children that they are expecting. Specifically, the pregnant person is counted as one (1) plus the number of children they expect to deliver. This pregnancy-adjusted household size is used to determine the applicable FPL for the pregnant person as well as for other members of their household.210 R.I. Code R. 210-RICR-30-00-5.4
Amended effective 8/25/2020
Amended effective 10/1/2024