Which states use 209(b) rules or have adopted MAGI‑like methodologies for non‑MAGI Medicaid groups?
Executive summary
Most non‑MAGI Medicaid eligibility still relies on SSI-based methodologies, but federal guidance allows states to either continue older SSI/AFDC‑era rules, elect a MAGI‑like methodology for non‑MAGI groups, or — in a subset of states operating under section 209(b) — apply more restrictive, state‑specific criteria; the specific list of 209(b) states and the lineup of states that have formally adopted MAGI‑like approaches for non‑MAGI groups are not enumerated in the provided reporting [1] [2]. Available federal and policy reporting shows the framework and recent trends — including that most states have moved to align processes across MAGI and non‑MAGI populations — but does not supply a state‑by‑state checklist in the material supplied here [3] [4].
1. What “209(b)” and “MAGI‑like” actually mean in practice
Section 209(b) refers to a statutory option allowing some states to apply eligibility rules for aged, blind, and disabled Medicaid applicants that are more restrictive than federal SSI criteria, meaning those states can retain older, state‑specific income/resource rules while still largely using SSI methodologies as a baseline [1] [5]. By contrast, a “MAGI‑like” methodology is the option described in CMS implementation guidance that lets states apply MAGI‑style income counting and household composition rules (originally created under the ACA for children, pregnant women, parents and adults) to non‑MAGI groups in lieu of the AFDC/SSI approaches, effectively reducing divergence in how income is counted across populations [2] [6].
2. What the federal guides and implementation manuals say about state choices
CMS implementation guides explicitly provide states the option to use MAGI‑like methodologies for groups traditionally evaluated under non‑MAGI rules and outline how states may define household, parental relationships, and disregards when electing those methods, signaling an administrative pathway for states to harmonize rules across eligibility groups [2]. At the same time, CMS reiterates that some individuals remain exempt from MAGI rules — notably those eligible by virtue of age, blindness, or disability — and that states with 209(b) authority may continue to apply more restrictive SSI‑based criteria [1] [5].
3. What empirical reporting shows about states’ actual practices
Recent policy surveys and briefings show convergence: by 2024–2025, most states had moved to use similar processes for MAGI and non‑MAGI populations (KFF reports that 38 states use the same processes to determine income eligibility across pathways), suggesting administrative alignment even where statutory differences persist [3]. Advocacy and policy groups note that non‑MAGI pathways still typically involve asset tests and “spend down” options for those with high medical costs — mechanisms that MAGI eliminated — and that 209(b) states must allow spend‑down rules under federal law [7] [8].
4. Limits of the available reporting: no state‑by‑state list in the provided sources
The documents and summaries included here define the options, describe the mechanics and trends, and report aggregate counts or policy directions (for example, the KFF survey aggregate and the CMS implementation guides), but they do not provide a direct list of which states currently operate under 209(b) or which states have affirmatively elected MAGI‑like methodologies for non‑MAGI groups; therefore a precise state roster cannot be produced from the supplied material [2] [1] [3].
5. How to get a definitive state list and next likely developments
A definitive, current list requires consulting state Medicaid plan documents or CMS/state inventories that enumerate 209(b) designations and state plan amendments electing MAGI‑like methods; CMS implementation guides and KFF’s state surveys are the natural next sources to query for the up‑to‑date, state‑by‑state picture [2] [3]. Policy momentum — including recent Federal directives to align renewal and enrollment simplifications across MAGI and non‑MAGI groups — makes it likely more states will either harmonize procedures administratively or submit amendments to adopt MAGI‑like counting rules in coming years [4].