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Eligibility-MAGI Programs for Adults

Certain medical assistance programs use the Modified Adjusted Gross Income (MAGI) rules to figure out whether you qualify for the program. MAGI rules use IRS-defined concepts of income and household. This means that your federal tax filing status and who you claim as tax dependents determines:

  • your household size; and
  • whose income we count.

Pregnant woman at doctor visitAdult medical assistance programs that use the MAGI rules include:

  • pregnant women medical assistance;
  • parents/caretaker relatives medical assistance;
  • the NH Health Protection Program (NHHPP) and the NH Health Protection Program – Medically Frail (NHHPP-M); and
  • Family Planning medical assistance.

General Eligibility Rules

Citizenship Status/Immigration & Identity: You must be either a US citizen or be a qualified alien and you must be who you say you are.

Residency: You must live in New Hampshire, intend to remain in New Hampshire, and not be getting medical assistance from another state. A student entering NH for educational purposes is not considered a resident of NH.

Age: You must be a certain age for some programs. If a program has an age limit, you must meet the age limit.

Social Security Number (SSN): Each individual requesting assistance must furnish an SSN or proof of an application for an SSN.

Tax Filing Status: You must tell us about your expected IRS tax filing status and your tax dependents.

Financial Eligibility Rules

You must meet the program's income rules to qualify for the program.

Household Income: Most kinds of income for all members of your household are counted when we see if you qualify for medical assistance. Some examples of counted income are:

  • Wages and Salary
  • Self-employment income
  • Tips, bonuses, and gratuities
  • Unemployment benefits
  • Social Security Benefits

We may not count all of your income because certain expenses can be subtracted from your total income. If, after subtracting your expenses, your total net income equals or falls below the monthly net income limits for the number of people in your household, you are considered income-eligible. Please see the DFA Net Monthly Income Limits Adobe Acrobat Reader Symbol for the specific income requirements for the various programs. Please see the DFA Program Fact Sheet Adobe Acrobat Reader Symbol for the specific deduction and disregards that are allowed for the various programs.

Potential Income: You must explore and apply for all potential sources of income. For example, you must apply for the following benefits if you potentially qualify for them:

  • Social Security Benefits
  • Retirement Benefits or Pensions
  • Unemployment or Worker's Compensation
  • Third-Party Medical Coverage
  • VA Benefits (including Aid and Attendance)
  • Disability Benefits or Pensions
  • Contributions from any Liable Third Party

Special Rules for Pregnant Women Medical Assistance

You must be pregnant to qualify for this type of assistance. Coverage for this type of assistance may continue for 60 days post-partum.

Special Rules for Parent/Caretaker Relative Medical Assistance

For this type of assistance, you must be a caretaker relative or parent of a dependent child, defined as a child under age 18 (or under age 19 and a full-time student in secondary school or equivalent vocational or technical training). The dependent child must live with you and must be deprived of parental care.

Deprivation of parental care means a parent is unable to support or care for the child. The reason the parent is unable to support or care for the child could be because the parent has died, is continually absent, is unemployed, or because of physical or mental incapacity. Each one of these reasons has specific rules associated with the definition of the deprivation type, and proof of the deprivation must be given to us as a condition of eligibility.

Special Rules for the NH Health Protection Program (NHHPP) and the NH Health Protection Program – Medically Frail (NHHPP-M)

For this type of assistance:

  • You must be at least age 19 but younger than age 65;
  • You cannot be pregnant at the time of application;
  • You cannot be entitled to or enrolled in Part A or B Medicare benefits; and
  • You cannot otherwise qualify for or be enrolled in any mandatory Medicaid coverage (like APTD or ANB).

In the NHHPP:

  • If you are unemployed, you must contact NH Employment Security for help in finding a job and filling for unemployment benefits, if eligible.
  • If you or someone in your family has access to health insurance through an employer, you must take that insurance if it is determined to be cost-effective. If it is cost-effective for you to take the employer offered health insurance, we will pay to the employee the employee’s share of the insurance costs that are deducted from the employee’s paycheck.
  • If you or someone in your family does not have access to health insurance through an employer, or you do have access to insurance but it is not cost-effective, your medical assistance will be covered through the Alternative Benefit Plan, offered through NH’s Medicaid Care Management (MCM) Program.
  • Coming in 2016, the Premium Assistance Program (PAP) will begin. If you qualify, we will continue to cover the costs of your medical assistance, but your coverage will be provided by health insurance plans that qualify to be on the Health Insurance Marketplace.

Special Rules for Family Planning Medical Assistance (FPMA)

FPMA offers limited coverage for family planning or family planning-related medical services or supplies only. For this type of assistance:

  • You cannot be pregnant;
  • You cannot already be a Medicaid recipient;
  • You cannot be concurrently receiving QMB or SLMB; and
  • You cannot qualify for or be enrolled in Part A or B Medicare benefits; and
  • Both males and females qualify for FPMA and there is no age requirement, however FPMA services are only available to eligible individuals who have reached reproductive maturity.

 

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New Hampshire Department of Health and Human Services
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