Letter on Application of Liens, Adjustments and Recoveries, Transfer of Asset Rules and Post-Eligibility Income Rules to MAGI In

This letter provides guidance to states on how the long-term services and supports-related rules apply to individuals who are eligible for Medicaid under Modified Adjusted Gross Income (MAGI) eligibility rules, and receive coverage for long-term services and supports (LTSS). The vast majority of people in need of Medicaid-covered LTSS will qualify under eligibility categories related to age or disability. The MAGI rules do not apply to these categories, and states generally are not required to offer LTSS in the Alternative Benefit Plans (ABPs) that are available to MAGI individuals. However, some people who need LTSS may qualify for Medicaid under MAGI rules. This guidance is intended to address states’ questions regarding whether the various Medicaid LTSS rules, including the estate recovery rules, will apply to MAGI individuals who are eligible for LTSS coverage.