Section R9-22-1427. Eligibility Under MAGI

A.      Caretaker Relatives. An individual is eligible for AHCCCS medical coverage as a Caretaker Relative when the individual meets the following requirements:

1.        Is a caretaker relative as defined in R9-22-1401.

2.        The total countable income under R9-22-1420(B) does not exceed 106 percent of the FPL for the number of peo- ple in the MAGI income group.

B.       Continued medical coverage.

1.        A caretaker relative eligible under subsection (A) and all dependent children eligible under subsection (D) in the caretaker relative’s MAGI income group are entitled to continued AHCCCS coverage for up to 12 months if eli- gible under subsection (B)(1)(c)(i) and up to four months if eligible under subsection (B)(1)(c)(ii) if the MAGI income group’s income exceeds the limit for the income group’s size and the following conditions are met:

a.         The caretaker relative still lives with a dependent child;

b.        A caretaker relative in the income group received AHCCCS medical coverage under this Section for three calendar months out of the most recent six months; and

c.         The loss of AHCCCS coverage under this Section is due to:

i.         Increased earned income of a caretaker relative, or

ii.        Increased spousal support.

2.        An applicant may be added to the continued medical cov- erage under subsection (B)(1), if the applicant did not reside in the household at the time continued medical coverage under this Section was determined and the applicant is:

a.         The spouse or dependent child of a caretaker relative receiving continued medical coverage, or

b.        The parent of a dependent child who is receiving continued medical coverage.

C.      Pregnant Women. A pregnant woman is eligible for AHCCCS medical coverage when the total countable income under R9- 22-1420(B) does not exceed 156 percent of the FPL for the number of people in the MAGI income group. A pregnant woman who applies for AHCCCS medical coverage during the pregnancy or postpartum period and is determined eligible, remains eligible throughout the postpartum period. The post- partum period begins the day the pregnancy terminates and ends the last day of the month in which the 60th day following pregnancy termination occurs.

D.      Children. A child less than 19 years of age is eligible for AHC- CCS medical coverage when the total countable income under R9-22-1420(B) does not exceed the following percentage of the FPL for the number of people in the MAGI income group:

1.        147 percent for a child under one year of age,

2.        141 percent for a child age one through five years of age, or

3.        133 percent for all other persons.

E.       Adults. An individual is eligible for AHCCCS medical cover- age when the individual meets the following eligibility requirements:

1.        Is 19 years of age or older but less than 65 years of age;

2.        Is not pregnant;

3.        Is not eligible for AHCCCS Medical Coverage under any other coverage group listed in 42 U.S.C. 1396a(a)(10)(A)(i);

4.        Is not entitled to or enrolled for Medicare benefits under Part A or Part B;

5.        The total countable income under R9-22-1420(B) does not exceed 133 percent of the FPL for the number of peo- ple in the MAGI income group; and

6.        When the individual is a caretaker relative, but has income exceeding the limit in subsection (A)(2), each child under age 19 living with the individual is receiving AHCCCS medical coverage or KidsCare, or is enrolled in minimum essential coverage as defined in 42 CFR 435.4.

Historical Note

New Section adopted by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). Section repealed; new Section made by exempt rulemaking at 7

A.A.R. 4593, effective October 1, 2001 (Supp. 01-3).

Section repealed; new Section made by final rulemaking at 11 A.A.R. 4942, effective December 31, 2005

(Supp. 05-4). Section R9-22-1427 repealed; new Section R9-22-1427 made by final rulemaking at 20 A.A.R. 192, effective January 7, 2014 (Supp. 14-1).