What you need to know about MAGI (Modified Adjusted Gross Income)
- MAGI started with the Affordable Care Act (ACA). MAGI is a formula used for calculating income eligibility for Medicaid, CHIP, other financial help, and now Ryan White HIV/AIDS Program (RWHAP) services and Texas HIV Medication Program (THMP).
- The Health Resources and Services Administration (HRSA) HIV AIDS Bureau (HAB) encourages all states to align the Ryan White HIV/AIDS Program (RWHAP) eligibility requirements with MAGI.
- Because Ryan White (RW) is payer of last resort (PoLR), funded providers must make reasonable efforts to ensure eligible RW clients enroll in health insurance and secure non-RW funds whenever possible. MAGI supports coordination with the eligibility determination processes for insurance affordability programs for PoLR.
- By statute, Ryan White funds may not be used “for any item or services to the extent that payment has been made, or can reasonably be expected to be made...” by another payer source.
- MAGI was implemented with three goals in mind:
- To streamline eligibility guidelines among local agencies and with the THMP program.
- To help ensure that agencies have access to reliable income documentation.
- To reduce the client burden in that income information will often be required only once a year with a self-attestation being acceptable at the six-month recertification.
Texas HIV Medication Program