Attachment III
MAGI Eligibility
Categorical and Coverage Codes
MAGI Income Standard (FPL)
Individual Categorical
Code
Coverage Code
Pregnant Women
223% FPL
92 (new)
01, 30
Presumptive Pregnant Women
223% FPL
36
__
Infants and Children < 1 year
223% FPL
45
01, 30
1 - 5 years
154% FPL
46
01, 30
6 - 18 years
110%
47
01, 30
6 - 18 years
> 110% < 154% FPL
84
01, 30
S/CC & 19 & 20 year olds living alone
<100% FPL
09
01, 30
S/CC & 19 & 20 year olds living alone
> 100% <138% FPL
93 (new)
01,30
S/CC & 19 & 20 year olds living
with parents
>138% <155% FPL
95 (new)
01, 30
S/CC & 19 & 20 year olds living
with parents
<138%
96 (new)
01, 30
Parents/Caretaker Relatives
138% FPL
94 (new)
01, 30
Family Planning Benefit Program (FPBP)
223% FPL
68(FP), 69(FNP)
18
Presumptive (case type 21)
223% FPL
68(FP), 69(FNP
18
FPEP
223% FPL
68(FP), 69(FNP
27
MAGI Group