Determining MAGI Medicaid Household Size - State Options Review

Often the MAGI Medicaid household size is the same as the tax filing household size. However some variations occur the person is not filing taxes and will not be claimed as a dependent, or if someone is a dependent but not claimed by all the parents they live with, or if someone is pregnant.

Calculating household size properly is essential to accurate Medicaid eligibility determinations. Two main state options exist, and selected options for each state are listed here. These options help us build our 50 state Medicaid eligibility calculator which provides guidance on selecting the proper household size. Multiple people that would be in the same SNAP household can have different household sizes for MAGI Medicaid.

The household size for a pregnant woman will always include the expected number of children (i.e. +1, +2 for twins). For other household members applying for Medicaid, state option determine whether to count the pregnant woman in the household as herself (1), herself + 1 (2), or herself + expected children (EXPECTED). Counting expected children will always lead to a higher income limit for Medicaid eligibility. If a pregnant woman is only counted as 1, this would be a situation where the household size could be different for each individual in a household.

The more common option is to count all expected children for all household members.

Some Medicaid households that are not strictly tax-household include children, where state options include "under 19" or "under 19, or in the case of full-time students, age 21." Counting full-time students as children will lead to larger household sizes with higher income limits for Medicaid eligibility.

The more common option is to not include students age 19 and 20 as "children."

Following this California Guide for Calculating MAGI Medicaid household size we can see the impact of these state options. First, anywhere that says "or under age 21 if full time student" would be removed without that state option. Second, in the bottom right corner, rules about expected children for other household members would change depending on state options.

States file document S10 "MAGI-Based Income Methodologies" with their selected options. For all but four states the document could be found, for those, other sources such as handbooks and other references were used. Data may be out of date due to superseding documents published.