Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
02000
03100 MAGI Budgeting Units - A MAGI Budget Unit is defined as a person or group of people that must be included in a single applicant’s eligibility determination. The budget unit is based on the expected tax household. All Family Medical programs determinations are based on the concept of the Individual Budgeting Unit (IBU.) See 2140 for temporary absences.
There is one Budget Unit for each member applying for coverage. Tax household members may be included in the Budget Unit of other household members, but each individual has a unique Budget Unit that is used to determine their individual eligibility. This is known as the Individual Budgeting Unit (IBU).
Much of the MAGI determination is based on an applicant’s planned tax household. What we need to know is if the applicant intends to file taxes and who they intend to claim on the tax return. The budget unit is not based on how an individual actually files their taxes, but on how they plan to file them. The questions on the application should be answered based on how the individual would file taxes if they filed today.
Obtaining tax household information is a requirement of eligibility. In the application process, each individual is required to respond to a set of questions which are used to determine the budgeting unit. This information includes whether or not the individual plans to file taxes, if they will file jointly with a spouse, and who will be claimed as tax dependents on that tax return. It is also necessary to obtain information about the tax household when an individual is being claimed by someone not in their home. The information may be obtained verbally or through KEES form V777.
Note: Tax household members not living in the home must be added to the case in KEES. This allows them to be used for the individual budget unit. Their income must also be included so it can be counted for the individual budget unit.
Refer to the MAGI – Building Individual Budget Units and MAGI Individual Budget Units (IBU) Examples found in the KDHE Eligibility Policy Appendix for additional information.
3110 Filers - Individuals who plan to file taxes or are expected to be claimed as a tax dependent by someone else are considered Filers. Their IBU includes themselves, their spouse if living together and all individuals claimed as dependents on their tax return.
3120 Non-Filers - Individuals who do not intend to file a tax return or be claimed as a tax dependent, are considered Non-Filers. Their IBU includes the following:
IBU for an adult: Individual, spouse, and individual’s children (biological, adopted, and/or step) who are under age 19 if living in the home.
IBU for an individual under age 19: Individual, individual’s parents (biological, adopted, and/or step), individual’s siblings (natural, adopted, and step) who are under age 19 if living in the home, and individual’s children (biological, adopted, or step) who are under age 19 if living in the home.
3130 Individuals Claimed as a Dependent - When an individual is claimed as a dependent by another, there are a series of questions we must ask in order to determine if the individual’s IBU is based on the tax household or on the Non-Filer rules. These questions are referred to as ‘exceptions’ on the MAGI IBU Examples document. These questions are:
• Is the individual being claimed as a dependent by someone other than their spouse or parent (biological, adopted, or step?)
• Is the individual under age 19 and being claimed as a tax dependent by only one parent, but living with both parents (biological or adopted?)
• Is the individual under age 19 and being claimed as a tax dependent by a parent (biological or adopted) not in the home?
A ‘yes’ answer to any of these questions indicates that the exception has been met and the individual’s IBU is determined based on the Non-Filer rules.
When none of the exceptions is applicable, the IBU includes the following:
The Individual, the tax filer claiming the individual, the tax filer’s spouse if filing jointly, and all additional persons the tax filer is including as tax dependents. Note: In this situation, it is not relevant if the tax filer, tax filer’s spouse, and other tax dependents live in the same home as the individual.
3140 Inclusion of the Spouse - If not already included in the IBU using the rules above, the spouse of the taxpayer and the spouse of the individual shall be included in the IBU when they reside in the same home.
3150 IBU for a Pregnant Woman - When determining the IBU of the pregnant woman, add the number of babies that are expected for that pregnant person. This is based on self-attestation by the applicant. If staff determine the reported information on the number of babies expected is questionable, verification may be requested.
03200 Additional IBU Provisions - The following additional principles are applicable to MAGI Individual Budgeting Units.
3200.01 - Individuals aged 18 and younger who plan to file taxes, reside with their parents and their parents are not claiming them as a tax dependent are to be determined using the non-filer rules as outlined in 3120.
3200.02 - Marriage establishes legal responsibility between the couple. Any marriage (including same sex) validly established in Kansas or another jurisdiction either through a civil licensed contract or by common-law (see 3200.03) shall be recognized. Once established, the marriage (both civil and common-law) may only be dissolved through a formal divorce court proceeding.
3200.03 - A common-law marriage establishes legal responsibility between the couple. To be considered common-law married, the couple must meet all of the following conditions:
a. have the legal capacity to marry, meaning they are at least 18 years old, legally competent, and not already married to someone else
b. consider themselves to be presently married
c. hold themselves out to the public as married
3200.04 - When an unmarried couple indicates they will file jointly, staff must first make contact to clarify their tax filing intention. If after contact, the couple still attests that they are not married or common-law married and attest to filing jointly, the non-filer rules shall be used for all household members.
3200.05 - In situations where an individual is a member of the budgeting unit, but their income is not included in the determination, such as when the IBU member is an SSI recipient, the individual will be provided with a role in KEES called ‘Family Size Only’.