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From: Hillsberg, Bonnie S.(CMS/CMCS)
[mailto:[email protected]] Sent: Tuesday, January 27,
2015 11:20 AM Subject: RE: New CMS Tribal Fact Sheets: Special
Protections for AI ANs and AI AN Trust Income and MAGI
NEW INFORMATION – Please forward to your distribution lists and
colleagues: CMS Tribal Affairs is pleased to announce the release
of two new fact sheets. The first fact sheet explains the
Protections for American Indians and Alaska Natives (AI ANs) in the
Marketplace, Medicaid and CHIP. The second fact sheet describes
Modified Adjusted Gross Income (MAGI) and what that means for AI AN
Trust Income. These fact sheets support our outreach and education
efforts to encourage AI AN enrollment in CMS programs. The fact
sheets were developed with input from the CMS Tribal Technical
Advisory Group and our federal partners at IHS and HHS IEA. Please
feel free to distribute further. The fact sheets will be available
for downloading on the CMS AI AN website at:
http://go.cms.gov/AIAN-OutreachEducationResources and will be
available to be ordered from the CMS warehouse in a few weeks.
mailto:[email protected]://go.cms.gov/AIAN-OutreachEducationResources
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Health Insurance Marketplace Protections for American Indians
and Alaska Natives
Marketplace Protections:The Marketplace provides special
benefits for AI/ANs, but some are limited to members of federally
recognized tribes and Alaska Native Claims Settlement Act (ANCSA)
corporation shareholders. Special Enrollment Periods (SEP): Tribal
members and ANCSA
shareholders can enroll in the Health Insurance Marketplace
throughout the year, not just during the yearly Open Enrollment
period. In Federally Facilitated Marketplace (FFM) states,
non-tribal members applying on the same application as a tribal
member can take advantage of the SEP.
Tribal members and ANCSA shareholders with income at or below
300% of FPL:◊ May be able to enroll in a zero cost sharing plan,
which means no
copays, deductibles, or coinsurance when receiving care from
Indian health care providers or when receiving Essential Health
Benefits (EHBs) through a QHP.
◊ There is no need for a referral from an Indian health care
provider when receiving EHBs through the QHP.
Tribal members and ANCSA shareholders with incomes above 300%
FPL:◊ Can enroll in a limited cost sharing plan, which means no
copays,
deductibles, or coinsurance when receiving care from Indian
health care providers.
◊ Will need a referral from an Indian health care provider to
avoid cost sharing when receiving EHBs through a provider outside
the Indian health system.
Tribal members and ANCSA shareholders can enroll in a zero cost
sharing or limited cost sharing plan at any metal level, including
less expensive bronze plans.
Tribal members and ANCSA shareholders who qualify for cost
sharing reductions are not exempt from premiums. However, they may
qualify for Advance Premium Tax Credits depending on income. All
AI/ANs can apply for an exemption from the shared responsibility
payment (tax penalty/fee) that others must pay when they file their
taxes if they don’t have health insurance.
Medicaid and CHIP Protections:All AI/ANs have the following
Medicaid and CHIP protections: Do not have to pay premiums or
enrollment fees. If they receive care from an Indian health care
provider or through referral
to a non-Indian provider, they do not have to pay any cost
sharing, such as deductibles or copayments.
The Health Insurance Marketplace benefits American Indians and
Alaska Natives (AI/ANs) by providing increased opportunities for
affordable health coverage through a Qualified Health Plan (QHP)
bought in the Marketplace, through Medicaid, or the Children’s
Health Insurance Program (CHIP).
Did you know?
@CMSGov
#CMSNativeHealth
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Local Indian health care providers may be able to provide a
letter to their beneficiaries to verify eligibility for these
protections.
Certain types of Indian income and resources are not counted
when determining Medicaid or CHIP eligibility. For example: ◊ Per
capita payments from a tribe that come from natural resources,
usage rights, leases, or royalties ◊ Payments from natural
resources, farming, ranching, fishing, leases, or profits from
Indian trust land (including
reservations and former reservations) ◊ Money from selling items
that have tribal cultural significance, such as Indian jewelry or
beadwork
NOTE: Per capita income from Indian gaming is not excluded and
should be reported.
Indian Exemption:Due to a policy change, all AI/ANs, including
individuals who are otherwise eligible for services through an
Indian health care provider, can now apply for an exemption from
the shared responsibility payment (tax penalty/fee) in two
ways.
1. Apply when filing a federal income tax return through
self-attestation or by providing an Exemption Certificate Number
(ECN).
Self-attestation◊ Do not need to submit documentation
because
an individual can self-attest that they or a member of their tax
household are eligible for an exemption
◊ Should retain the same documentation as if filing for an
exemption through the Marketplace (see Step 5 of the exemption
application)
◊ Must be able to produce this documentation if audited by
IRS
Provide an ECN (the number received from the Marketplace
contractor)◊ Keep this number, because it will need to be
provided every year when filing taxes◊ Because an individual has
proven eligibility for
an ECN, he or she will not need to produce tribal or eligibility
documentation in case of an IRS audit
2. Apply through the Marketplace by completing an exemption
application and mailing it with supporting documentation.
Must submit documentation of membership in a federally
recognized tribe/ANCSA corporation, or eligibility for services
through an Indian health care provider (see Step 5 of the exemption
application)
Will receive an ECN.
The ECN is valid for a lifetime, but it must be reported if
required to file an income tax return to avoid a shared
responsibility payment (tax penalty/fee). If an individual does not
have an ECN, he or she must file for the Indian exemption when
completing his or her federal income tax return every year to avoid
the shared responsibility payment (tax penalty/fee). Even if an
individual applies for an exemption from the fee, he or she can
also apply for QHPs on the Marketplace, or for Medicaid and CHIP
programs, and still receive services from an Indian health care
provider.
Forms to apply for the Indian exemption on the Marketplace are
available for downloading
at:http://marketplace.cms.gov/getofficialresources/publications-and-articles/tribal-exemption.pdf
For more information, visit: www.healthcare.gov/tribal
Contact Info:
www.healthcare.gov/tribal @CMSGov #CMSNativeHealth
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@CMSGov #CMSNativeHealthwww.healthcare.gov/tribal
American Indian and Alaska Native Trust Income and MAGI
Q: What is Modified Adjusted Gross Income (MAGI)?A: MAGI is your
adjusted gross income, as determined for federal
income tax purposes, with certain types of income added in and
subtracted out.
Q: What is the purpose of MAGI?A: MAGI is used to determine an
individual’s eligibility for premium
tax credits and cost sharing reductions for Qualified Health
Plans purchased through the Health Insurance Marketplaces. MAGI is
also used to determine eligibility for families and children
coverage groups in Medicaid and the Children’s Health Insurance
Program (CHIP).
Q: Are there special rules for calculating MAGI for American
Indians and Alaska Natives (AI/ANs)?
A: Yes. MAGI is based on taxable, adjusted gross income reported
to the Internal Revenue Service (IRS). Because some types of income
specific to AI/ANs are non-taxable, this income is excluded when
determining eligibility for Marketplace tax credits, cost sharing
reductions, Medicaid, and CHIP. Certain additional types of AI/AN
income are excluded when determining eligibility for Medicaid and
CHIP, even though they might be taxable. This means that your MAGI
might be slightly higher for the purposes of Marketplace assistance
than it is for Medicaid eligibility.
You may qualify for lower cost health insurance coverage on the
Marketplace. When you provide your MAGI, you can find out if you’re
eligible for premium tax credits and other savings that can lower
the cost of health insurance.
Learn how MAGI works, the types of income counted and excluded,
and the special rules for AI/ANs for the Marketplace, Medicaid, and
CHIP.
Did you know?
Use of any information from this document is for general
information only and does not represent personal tax advice, either
express or implied.
@CMSGov
#CMSNativeHealth
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@CMSGov #CMSNativeHealth
Q: What types of AI/AN income are generally exempt from
MAGI?
A: The following categories of income are generally excluded
from an AI/AN’s MAGI:
Distributions from Alaska Native Claims Settlement Act (ANCSA)
Corporations and Settlement Trusts
Distributions from trust/reservation property Income from
property and rights related to
hunting, fishing, and natural resources Income from the sale and
use of cultural/
subsistence property Student financial assistance provided by
the
Bureau of Indian Affairs and/or a Tribe Income that falls within
the IRS General Welfare
Doctrine Any other income that is non-taxable according to
federal law or IRS guidance
You should contact your Tribe if you are unsure whether a
certain type of income is exempt from MAGI.
Q: Income exempt under the “General Welfare Doctrine” is
excluded from MAGI. What is the General Welfare Doctrine?
A: Payments made under social benefit programs for the promotion
of general welfare may be excluded from gross income under a
concept known as the general welfare doctrine. This applies only to
governmental payments out of a welfare fund based upon the
recipient’s need, and not as compensation for services. When
distributions to tribal members are made equal (per capita) and not
based on need, then they do not fall under the general welfare
doctrine. Benefits payable regardless of the financial status,
health, educational background, or employment status of the
recipient may be included in gross income of recipient.
Q: Is my tribal gaming per capita payment excluded from MAGI?A:
No. Gaming per capita payments are taxable and must be included in
your MAGI.
Q: The list of AI/AN income includes distributions and payments
from activities on trust property. Does that property have to be
located on a reservation for the income to be excluded from
MAGI?
A: No. This income is exempt from MAGI so long as it is derived
from property that is held in trust by the federal government,
subject to federal restrictions, located on an Indian reservation
or within the most recent boundaries of a prior federal
reservation, or otherwise under the supervision of the Secretary of
the Interior.
www.healthcare.gov/tribal
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@CMSGov #CMSNativeHealth
Q: How do I list AI/AN income on the application for Marketplace
health insurance, Medicaid, and CHIP?
A: When filling out an application for health insurance in the
Marketplace, you will be asked to list your taxable income. You
should provide the same income that you report to the IRS when you
file your federal income tax. Do not include AI/AN income that the
IRS exempts from taxation as part of your taxable income.
In Appendix B of the Marketplace application, you will be asked
to list certain types of AI/AN income that you previously included
in Step 2 of your application. Even though this income is taxable,
it still may be excluded from MAGI for the purposes of Medicaid and
CHIP eligibility. You are asked to list this type of income on
Appendix B to make sure that it is not counted toward your MAGI as
part of the Medicaid and CHIP eligibility determination.
If you don’t have these types of income, just put a zero on the
application after the questions in Appendix B. If you do have this
type of income, list what kind you have and how much of it you
receive.
Do not list any per capita income from gaming in Appendix B, as
it is taxable and included in MAGI.
Q: Who should I contact for help when filling out the
Marketplace application regarding my exempt AI/AN income?
A: You should contact your Tribe or the enrollment assister at
your local Indian Health Service, tribe or tribal organization, or
urban Indian organization. You can also check with a Navigator or
the Help Desk at your State’s Marketplace or at Healthcare.gov. If
someone helps you prepare your taxes, you can also ask them.
Specific Types of AI/AN Exempt Income
Below are some specific types of AI/AN income that may be
excluded from your MAGI when determining eligibility for Medicaid,
CHIP, and the tax credits and cost sharing reductions in the health
insurance Marketplace. Please note that these are just examples and
that this list is not exhaustive.
Distributions from ANCSA Corporations and settlements trusts
Cash distributions from an ANCSA corporation or settlement
trust
Stock or bonds issued by or acquired from an ANCSA
Corporation
A partnership interest distributed by an ANCSA Corporation, as
well as subsequent partnership distributions
Land or an interest in land (including land or an interest in
land received from an ANCSA Corporation as a dividend or
distribution on stock)
Per capita payments or distributions from trust/reservation
property
Rents from any such lands and any structures on the land
(housing, retail facilities, etc.)
Royalties or other compensation received from oil and gas
production, mineral extraction, timber harvesting, and similar
activities
Profits or revenues derived from economic activity on the land,
such as the operation of motels, retail stores, gas stations, farms
and ranches, etc.
www.healthcare.gov/tribal
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@CMSGov #CMSNativeHealth
Payments from funds held in trust by the Secretary of Interior
for an Indian tribe, including interest and investment income
accrued while such funds are held in trust and initial purchases
made with such funds
Income derived from property and rights related to hunting,
fishing, and natural resources
Profits from the sale, lease, or harvest of mineral, timber, and
other such resources
Income derived from hunting, fishing, gathering, and harvesting
fish, wildlife, and plant resources pursuant to federally protected
rights, including off-reservation rights
Income from the sale and use of cultural or subsistence
property
Earnings from ownership interests and usage rights to items that
have unique religious, spiritual, traditional, or cultural
significance that support subsistence or traditional lifestyle
Materials such as the sale of sage or sweetgrass for use in a
healing or spiritual ceremony
The sale of artwork, pottery, or jewelry with cultural or
religious significance
Crafts made by AI/ANs from fish and wildlife resources taken for
personal or family consumption
Proceeds of subsistence fish and game
Student financial assistance provided by the Bureau of Indian
Affairs
Student financial assistance provided under programs in Title IV
of the Higher Education Act of 1965
Grants from the Bureau of Indian Education’s Higher Education
program
Payments that are exempt from federal income taxation under
federal statute
Per capita shares distributed to Indians pursuant to the Indian
Tribal Judgment Funds Use or Distribution Act (25 U.S.C. § 1401 et
seq.), including interest and investment income earned on Judgment
Funds while under administration
Distributions from certain federal settlements, such as the
Cobell v. Salazar class action settlement and some payments under
the Keepseagle v. Vilsack settlement
Income excluded under the General Welfare Doctrine Housing
assistance Education assistance Programs serving elders and
individuals with
disabilities Cultural and religious programs Transportation
programs Disaster relief Payments used to help establish
AI/AN-owned
businesses on or near a reservation
Contact Info:
www.healthcare.gov/tribal
Questions? Give us a call1-800-318-2596TTY: 1-855-889-4325
factsheet coverFrom: Hillsberg, Bonnie S.(CMS/CMCS)
[mailto:[email protected]] Sent: Tuesday, January 27,
2015 11:20 AM Subject: RE: New CMS Tribal Fact Sheets: Special
Protections for AI ANs and AI AN Trust Income and MAGI
AIAN_Protections_FactSheet 508AIAN_MAGI_FactSheet 508
