Section 210-RICR-30-00-5.6 - Determination of Household IncomeA. To be eligible for Medicaid using the MAGI standards, an applicant's current monthly household income must meet the standard applicable to the applicant's MACC group when converted to the FPL as shown below: MACC Groups | FPL Eligibility Threshold |
ACA Expansion Adults | One hundred thirty-three percent (133%) |
Children and Young Adults | Two hundred sixty-one percent (261%) |
Parents and Caretakers | One hundred thirty-six percent (136%) |
Pregnant People | Two hundred fifty-three percent (253%) |
B. When calculating whether an applicant is income-eligible for Medicaid under one of these coverage groups, the following factors must be considered: the members of the applicant's household that must be included; types of countable income; current income and reasonably predicted changes; and conversion of monthly income to the FPL standards.1. Countable household income - The Subsection below identifies all forms of countable income included when determining MAGI-based Medicaid eligibility, including those that are specific to Medicaid eligibility only. a. Adjusted Gross Income (AGI). Adjusted gross income is gross income adjusted by "above-the-line" deductions. AGI includes wages and salaries and income from a broad array of other sources, such as unemployment benefits, alimony, taxable interest, and capital gains. "Above-the-line" deductions are the adjustments people can make to their gross income. These include alimony payments, interest on student loans, and other items that appear on page one (1) of Form 1040. However, they do not include charitable contributions, mortgage interest and other "below-the-line" deductions.b. Social Security benefits. All Social Security income benefits are considered countable income when using the MAGI standard to determine eligibility for affordable coverage. This includes Social Security benefits that are considered both taxable and non-taxable income for federal tax purposes.c. Interest Income. Income received from bank accounts, money market accounts, certificates of deposit, and deposited insurance dividends are considered countable taxable income. Additionally, interest on some bonds issued by and used to finance state and local government operations is also counted for the MAGI even though treated as tax-exempt for federal tax purposes.d. Foreign earned income. Foreign earned income is countable for the MAGI. This includes all income received from sources within a foreign country or countries earned for services when either performed by: a U.S. citizen and a bona fide resident of a foreign country for an uninterrupted period of time that includes an entire tax year; or a U.S. citizen or resident who, during any period of twelve (12) consecutive months, is present in a foreign country for at least three hundred thirty (330) full days during that period.e. Medicaid specific adjustments to income. Special Medicaid adjustments are as follows: (1) Taxable lump sum payments (such as gifts, prizes, income and property tax refunds) are counted only in the month received.(2) Educational scholarships, awards or fellowships used for education purposes are excluded from consideration as income.(3) Certain types of income for American Indian/Alaska Native persons are excluded.f. Treatment of other sources of income for Medicaid eligibility are summarized in the table that follows: MAGI-Based Medicaid Eligibility Rules |
Income Source | Treatment of Income |
Self-employment income | Counted with deductions for most expenses, depreciation, and business losses |
Salary deferrals (flexible spending, cafeteria and 401(k) plans) | Not counted |
Child support received | Not counted |
Alimony paid | Alimony payments under separation or divorce agreements finalized after December 31, 2018 are not deductible by the payer. Alimony payments under separation or divorce agreement finalized on or before December 31, 2018 continue to be deductible by the payer except when such agreement is modified and when such modification expressly states that alimony is not deductible to the payer or includible in the income of the recipient |
Veterans' benefits | Not counted |
Workers' compensation | Not counted |
Gifts and inheritances | Not counted |
TANF and SSI | Not counted |
Qualified Lump Sum Income | Winnings less than eighty thousand dollars ($80,000) are counted as income in the month received. Winnings of at least eighty thousand dollars ($80,000) but less than ninety thousand dollars ($90,000) are counted as income in equal installments over two months. For every additional ten thousand dollars ($10,000) in winnings over ninety thousand dollars ($90,000), one (1) month is added to the period over which total winnings are divided, in equal installments, and counted as income. |
Discharged Student Loan Debt | Not counted |
Moving Expenses | Not counted |
Alimony Received | Alimony payments under separation or divorce agreements finalized after December 31, 2018 are not included in the income of the recipient. Alimony payments under separation or divorce agreements finalized on or before December 31, 2018 continue to be included in the income of the recipient for the duration of the agreement except when such agreement is modified, when such modification expressly states that alimony is not deductible to the payer or includible in the income of the recipient |
Tuition and Fees Deductions | Not counted |
2. Household members included in MAGI calculation - An individual's household income is the sum of the MAGI-based income of every individual included in the individual's household who is expected to be required to file a tax return. These rules are based on whether or not a person is "expected" to be required to file a tax return; it does not matter whether they eventually do so or not.3. Use of current income and accounting for reasonably predicted changes - For new Medicaid applicants, the State must use a household's current monthly income and household size when evaluating eligibility. A prorated portion of reasonably predictable changes in income, if there is a basis for anticipating the changes, such as a signed contract for employment, a clear history of predictable fluctuations in income, or other indications of future changes in income may be considered in determining eligibility. Future changes in income and household size must be verified in accordance with the verification and reasonable compatibility requirements as delineated in this Part.4. Comparing household income to the FPL - To determine income eligibility for Medicaid based on the MAGI calculation, the State must compare a household's current monthly income to the FPL guidelines for the appropriate household size. The State must use the most recently published FPL level in effect in the month during which an applicant applies for coverage. If an applicant's FPL level is within five (5) percentage points over the FPL for the coverage group for which they would be eligible, a disregard of five (5) percentage points of the FPL shall be added to the highest income eligibility standard listed above for that coverage group.210 R.I. Code R. 210-RICR-30-00-5.6
Amended effective 8/25/2020
Amended effective 10/1/2024