Current Functionality

The VaCMS is not evaluating the following people as MAGI Adult:

·         Individuals ages 19 through 64

·         Have been determined to be blind or disabled

·         Are not eligible for or enrolled in Medicare

·         Have income at or below 138% FPL (using MAGI rules)

·         Would otherwise be found eligible under the 300% category

These individuals are given a 300%AC code, a co-pay and are sent a Notice of Obligation. 

Interim Business Process for MAGI Adult Also Eligible as 300%

If all of the criteria are met for MAGI Adult eligibility, the worker will need to:

·         Override the AC to the appropriate MAGI Adult AC code

·         If the patient pay is more than “0”, override the patient pay to “0”

·         Suppress the Notice of Obligation

Interim Business Process Expected End Date

TBD

Updated: 11/30/2018