Accessing MAGI MC Budget

The MAGI MC budget can be accessed in CalSAWS or CalHEERS.

Accessing MAGI Budget Worksheet in CalHEERS

The CalHEERS Business Rules Engine (BRE) determines clients’ eligibility for MAGI MC. The MAGI MC budget worksheet can be located in CalHEERS by following these steps:

  1. Login to CalHEERS
  2. Click on the Search IndividualSearch Individual link

  3. Select a Search option [Case ID, SSN, Combo (Name/Date of birth)]
  4. Enter corresponding Search Value
  5. Click on [Search] button
  6. Click on a radio button to select an individual.
  7. Click on [View CaseView Case] button.

  8. Click on the View Eligibility ResultsView Eligibility Results link. Make sure to check the Date/Time Requested column to select the most recent budget worksheet.

  9. On the Household Eligibility Results SummaryHousehold Eligibility Results Summary Window click View Budget Worksheet.

MAGI Budget Worksheet

In CalHEERS, the budget worksheetbudget worksheet will display an individual budget for MAGI MC and a household budget for Advanced Premium Tax Credit (APTC) and Cost Sharing Reduction (CSR). The MAGI MC individual budget is a monthly budget, APTC and CSR budgets are annual.

CalHEERS Budget Worksheet

The following is a description of each line item in the CalHEERS Budget Worksheet:

CalHEERS MAGI Budget Worksheet Line

Description

Soft Paused Due To

This indicates whether or not the client has been placed on Soft Pause in CalHEERS.

  • Child (the member is a child)
  • Parent (the member is a parent)
  • Aged/Blind/Disabled (the member attests to being 65 or older, blind, or disabled)
  • Not Applicable (Soft Pause is not applied to this member)

Note: The 19 to 64 year old expansion group is not eligible for Soft Pause. Parent/Caretaker Relatives over 109% FPL (114% FPL if receiving Medicare) are no longer considered ‘Parent/Caretaker Relatives’ for the purpose of Soft Pause.

Person Primary Tax Filer

The value will be either Yes or No. This line indicates if the client is the primary tax filer in the tax filing household.

Person Included in Primary Tax Filer’s Tax Household

The value will be either Yes or No. This line indicates if the client is a member of the primary tax filer’s tax filing household.

Person Plans to File Taxes

The value will be either Yes or No. This line indicates if the client plans to file taxes for the current tax year.

Person Expected to be Required to File Taxes

The value will be either Yes or No. This line indicates if the client is required to file taxes for the current tax year.

Person Tax Filing Status

Individual’s tax filing status (i.e., Single, Married Filing Jointly, etc.)

Person Tax Dependent Status

The value will be either Yes or No. This line indicates if the client is a dependent of the primary tax filer’s tax filing household.

a. Employment Income (Monthly)

This is the individual’s earned income, not the tax filing household’s income.

b. Self-Employment Income (Monthly)

This is the individual’s earned income, not the tax filing household’s income from self-employment.

c. Other Income (Monthly)

This is the individual’s unearned income, not the tax filing household’s unearned income.

d. Total Income (Sum of a, b, c)

This is the individual’s total income, not the total tax filing household’s income.

e. Allowable Deductions (Monthly)

This is the individual’s allowable deductions, not the tax filing household’s deductions.

f. Total Income after Deductions (Subtract e from d)

This is the individual’s total income after allowable deductions have been subtracted.

g. Projected Monthly Income

This is how much income the individual projects as his/her monthly income not the tax filing household monthly income.

h. Countable Income (Sum of f and g)

Monthly income after allowable deductions.

i. Number of household members + Number of expected babies

Total tax filing household members.

j.  Federal Poverty Level for (i) (Monthly)

FPL dollar amount limit for individual.

k. FPL% for individual (Divide (h) by (j) and round)

FPL percentage for individual.

MAGI Medi-Cal Eligible?

The value will be either Yes or No. This line indicates if the client is eligible for MAGI MC.

Medi-Cal Access Program (MCAP) Eligible?

The value will be either Yes or No. This line indicates if the client is eligible for MCAP.

MCAP is a program for Pregnant Women between 213% - 322% FPL, previously known as (AIM).

County Children’s Health Initiative Program (CCHIP) Eligible?

The value will be either Yes or No. This line indicates if the client is eligible for CCHIP.

Meets 435.603(f)(2)(i-iii) to use a non tax filer household composition for MAGI Medi-Cal

The value will be either Yes or No. This line indicates the individual is being evaluated using non-tax filer rules.

Meets 435.603(i) exception to use APTC income/deduction calculations for MAGI Medi-Cal determination

Bounce Back Rule. The value will be either Yes or No.

Meets 435.119(c): Adults ineligible to the New Adult Group due to dependent child under age 19 without Minimum Essential Coverage

The value will be either Yes or No. Individual is not eligible for MAGI Adult Coverage group because his/her dependent child under 19 years old does not have Minimum Essential Coverage.

The age limit is under 21 years old if the dependent child is attending school full-time.

Related Topics

Budgeting

Use of Medi-Cal Budget Worksheets for Non-MAGI MC