LINES &

1040 INCOME TYPE MAGI M/C APTC/CSR

SCHEDULE
Employment1 (Wages2; salary; back pay; differential wage
payments; Government cost-of-living allowances; Nonqualified
deferred compensation; notes received for services;
severance pay; sick pay; vacation, annual leave, and paid
holidays; strike and lockout benefits, cash payments for stock
appreciation rights; allowances and reimbursements for
travel, transportation, or other business expenses; Count
commissions; advance commissions; tips; bonuses; awards; Count Taxable
Line 1 on 1040 Taxable
and fringe benefits not provided on a pre-tax basis (including Portion
Portion
non-clergy housing, meals and transportation), disability
pension under a plan that is paid for by your employer,
guaranteed annual wages paid during period of
unemployment by employer under a union agreement,
employer paid supplemental unemployment benefits from an
employer financed fund, fees received by clergy for services
performed, and other, W-2
Lines 2a & 2b on Count
Interest income (taxable and non-taxable), 1099-INT Count Gross
1040 Gross
Count
Count Taxable
Lines 3a & 3b on Taxable
Ordinary/qualified dividends, 1099-DIV Portion
1040 Portion
Count
Lines 4a & 4b on Count Taxable
Individual Retirement Account (IRA) distributions, 1099-R Taxable
1040 Portion
Portion
Pensions, Department of Defense Retirement Board military Count
Lines 4c and 4d on Count Taxable
retirement, endowment contracts paid as annuities and taxable Taxable
1040 Portion
annuities, 1099-R Portion
Social security benefits (taxable and non-taxable), SSA-1099,
including Social Security Disability Income (SSDI)

Note: Supplemental Security Income (SSI) and State

Lines 5a & 5b on Supplementary Payment (SSP) are not counted as income. Count
Count Gross
1040 Social Security survivors’ benefits for children are generally not Gross
counted as income either unless the total of one-half of the
child’s survivor’s benefits and all of the child’s other income
(including tax-exempt interest) is greater than $25,000 (if the
child is single).

Lines 5a & 5b on Railroad retirement benefits (taxable and non-taxable), RRB- Count
Count Gross
1040 1099 Gross

Count
Count Taxable
Line 6 on 1040 Capital gain (or loss), Form 8949, Schedule D Taxable
Portion
Portion
Line 7a on 1040 Other Income from Schedule 1, line 9 For Reference Only
Line 7b on 1040 Total Income (add lines 1, 2b, 3b, 4b, 4d, 5b, 6, and 7a.) For Reference Only

Covered California Outreach and Sales Division

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 Count
Count Taxable
Schedule 1, Line 1 Taxable refunds, credits, or offsets of state/local income taxes Taxable
Portion
Portion
Alimony received: Note: For divorce decrees or separation
Count Taxable Portion only for
agreements executed after Dec. 31, 2018, alimony received
Schedule 1, Lines 2a separating agreements
will no longer be counted as taxable income for the recipient,
& 2b executed before or on
and the tax deduction for alimony paid is eliminated.
December 31, 2018.

Count Taxable Count Taxable

Schedule 1, Line 3 Business (or loss), Schedule C
Portion Portion
Count
Count Taxable
Schedule 1, Line 4 Other gains (or losses), Form 4797 Taxable
Portion
Portion
Count
Rental real estate, royalties, partnerships, S-Corporations, Count Taxable
Schedule 1, Line 5 Taxable
Trusts, etc. (or loss), Schedule E Portion
Portion
Count
Count Taxable
Schedule 1, Line 6 Farm income (or loss), Schedule F Taxable
Portion
Portion
State or Federal unemployment compensation (see note),
1099-G; State Disability Insurance (SDI), when treated as
unemployment compensation, 1099-G;
State Disability Insurance (SDI), when treated as
unemployment compensation, 1099-G; Count
Count Taxable
Schedule 1, Line 7 Railroad Unemployment benefits, 1099-G; Trade Taxable
Portion
Readjustment allowances, 1099-G; Unemployment Portion
assistance under the Disaster Relief and
Emergency Assistance Act of 1974, 1099-G;
Unemployment assistance under the Airline Deregulation Act
of 1974 Program, 1099-G;
Note: Pandemic Unemployment Compensation due to
COVID-19 is counted toward the eligibility determination for
Covered California programs but not MAGI Medi-Cal.

Foreign Earned Income (taxable and non-taxable), Form Count

Schedule 1, Line 8 Count Gross
2555 Gross

1
Workers' compensation for an occupational sickness or injury is tax-exempt and not counted as income. However, if part of the
workers’ compensation reduces/replaces the recipient’s Social Security benefits received, that part of the workers’ compensation
is considered Social Security benefit and is counted as income.
2
In-Home Supportive Services (IHSS) wages received by IHSS providers who live with the recipient of those services are not
counted as income.

Other Income Types or Losses: Schedule 1, Line 8 (Publication 525)

OTHER INCOME TYPES OR LOSSES: SCHEDULE 1, LINE 8 MAGI APTC/CSR
(PUBLICATION 525) Medi-Cal
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 Accelerated death benefits/viatical settlements if the insured is Not Counted
chronically ill for costs of qualified long-term care or if the insured
is terminally ill not in excess of limit
Accelerated death benefits/viatical settlements paid to persons Count Taxable Portion
with a financial interest in the insured’s business
Activity not for profit, Pub.535 Count Taxable Portion

Adoption Assistance Payments Not Counted

Alaska Permanent Fund dividends Count Taxable Portion

Allowances and reimbursements for travel, transportation, or Count Taxable Portion

other business expenses
AmeriCorps State/National Stipend and Education Award Not Counted Count Taxable Portion
AmeriCorps National Civilian Community Corps Stipend and Not Counted Count Taxable Portion
Education Award
AmeriCorps Vista Stipend and Educational Award Not Counted Count Taxable Portion
Austrian general social insurance payments Not Counted
Awards Count Taxable Portion
Ball v. Swoap Payment Not Counted
Bartering, 1099-B, Pub. 525 Count Taxable Portion

Black Lung benefit payments Not Counted

Blood, plasma, sperm, egg, embryo, or compensation received Count Taxable Portion
for other body parts
Bonuses Count Taxable Portion
Bribes Count Taxable Portion
Business (or loss), Schedule C Count Taxable Portion
CalFRESH benefits Not Counted
California Work Opportunity and Responsibility to Kids Not Counted
(CalWORKs) cash grant
Cancellation of non-business debt Count Taxable Portion

Capital gain (or loss), Schedule E Count Taxable Portion

Cash payments for stock appreciation rights Count Taxable Portion
Child Support Not Counted
Clergy housing and utility allowance in excess of market rate and Count Taxable Portion
actual cost respectively
Clergy housing and utility allowance not in excess of market rate Not Counted
and actual cost respectively
Clinical trial participation remuneration and amounts in excess of Count Taxable Portion
expenses minus $2,000, 1099-Misc and 42 U.S.C. Section
1396a(e)(14)
Clinical trials participation to the extent of expenses incurred plus Not Counted
$2,000
Commissions, advance commissions Count Taxable Portion

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 County General Assistance cash grant Not Counted
Court awards/judgments/settlements for compensation for lost Count Taxable Portion
wages/profits, breach of contract, pension rights, interest on
awards, patent or copyright infringement and punitive damages
Court awards/judgments/settlements for personal injury or Not Counted
sickness/emotional distress and other compensatory property
damages. This does not include compensation for lost
wages/profits, breach of contract, pension rights, interest on
awards, patent or copyright infringement, or punitive damages
Coverdale Education Savings Account (ESA) Count Taxable Portion
Credit card insurance or disability payment Count Taxable Portion
Disability income received for injuries resulting directly from a Not Counted
terrorist or military action, not including training exercises
Disability income - taxed (taxed private disability insurance Count Taxable Portion
premiums paid for by employer) Pubs 525 and 907, 1099 and
1099-A
Disability Income - untaxed (untaxed private disability income Not Counted
insurance - premiums not paid by employer) Pubs 525 and 907
Disability pension under a plan that is paid for by your employer Count Taxable Portion
Disaster relief payments (qualified payments) Not Counted
Diversion cash assistance Not Counted
Down payment assistance Not Counted
Earned income tax credit Not Counted
Economic stimulus payments (federal) Note: do not count Not Counted
COVID-19 economic impact stimulus payments also known as
recovery rebates as income.
Employer contributions to certain pretax benefits funded by an Not Counted
employee’s elective salary reduction, such as amounts for a
flexible spending account
Employer paid supplemental unemployment benefits from an Count Taxable Portion
employer financed fund
Employment – wages, salary, back pay, differential wage Count Taxable Portion
payments;
Endowment contracts paid as a lump sum before death in Count Taxable Portion
excess of costs (veteran’s endowment contract not applicable)
Endowment contracts paid as a lump sum before death not in Not Counted
excess of costs, or paid upon death to a beneficiary
Energy Conservation Subsidy Not Counted
Farm income (or loss), Schedule F Count Taxable Portion
Federal Income Tax Return State Tax Return– (if state taxes Not Counted
were deducted on prior year Federal Income Tax return, the
state refund would be countable)
Fees received by clergy for services performed Count Taxable Portion
Foreign earned income (taxable and non-taxable), Form 2555 Count Gross

Foster care, maintaining a space in your home Count Taxable Portion

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 Foster care or other Title IV-E payments and transitional housing Not Counted
Fringe benefits not provided on a pre-tax basis (including non- Count Taxable Portion
clergy housing, meals and transportation)
Fringe benefits provided on a pre-tax basis by an employer, such Not Counted
as transportation benefits, parking, or moving expenses
Gambling winnings: gambling, lottery, raffles, Form W2-G (Per- Count Taxable Portion
capita distributions of Indian gaming revenue)
Gifts/cash contributions Not Counted
Government cost-of-living allowances Count Taxable Portion
Guaranteed annual wages paid during period of unemployment Count Taxable Portion
by employer under a union agreement
Health savings account Count Taxable Portion

Hobby income, or from an activity you did not expect to see a Count Taxable Portion
profit
Holocaust Victims Restitution/Victims of Nazi Not Counted
Persecution/German Reparation Payment
Host or hostess gift or gratuity Count Taxable Portion

Housing and Urban Development Section 8 rental vouchers or Not Counted

benefits
Income from the rental of personal property (not business Count Taxable Portion
income)
Income In-Kind (non-taxable fringe benefits) Pub. 525 Not Counted
Indian financing grants under title IV of the Indian Financing Act Not Counted
of 1974 to expand profit-making Indian-owned economic
Individual Retirement Account (IRA) distributions, 1099-R Count Taxable Portion
Inheritance or taxable portion of inherited IRA or inherited Not Counted
pension
In-Home Supportive Services caregiver wages paid to an Not Counted
enrolled provider who, regardless of relationship, resides with
the Medi-Cal beneficiary who receives those services from the: •
Advance Payments for Caregiver • In-Home Operations Waiver,
or • Nursing Facility/Acute Hospital Waiver, or • Personal Care
Services Program, or • In-Home Supportive Services Plus
Option, or • Community First Choice Option, or • In-Home
Supportive Services – Residual Program • Restaurant Meals
Allowance
Interest income (taxable and non-taxable), 1099-INT Count Gross
Interest income not received because the interest charged was Count Taxable Portion
below the applicable federal rate
Japanese or Aleutian Reparation payment whether from the Not Counted
United States or Canada
Job Corps earnings/stipend Count Taxable Portion

Jury duty pay in excess of costs Count Taxable Portion

Covered California Outreach and Sales Division
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 Kickbacks Count Taxable Portion

KinGAP payments Not Counted

Life insurance proceeds turned over for price, e.g. surrender in Count Taxable Portion
excess of the cost of the insurance
Life insurance proceeds upon death, including non-taxable Not Counted
annuity payments/proceeds
Loan proceeds Not Counted
Long-Term Care benefits (LTC) – non-taxable amount, 1099 Not Counted
LTC
Long-term care benefits – taxable amount – 1099 LTC Count Taxable Portion

Lost, stolen or damaged property payments Not Counted

Manufacturer incentive payments Count Taxable Portion

Medical savings account (Archer-Medicare), Pub. 969 Count Taxable Portion

Military allowances (BAH, BAS) Not Counted

Military hostile fire/imminent danger pay Not Counted
Mortgage assistance payments under Section 235 of the Not Counted
National Housing Act
Needs-based assistance Not Counted
Net Operating Loss Carryover, Subtract from other line 8 income Subtract Losses
in Schedule 1, Pub. 536
Netherlands WUV victims of persecution Not Counted
Nonqualified deferred compensation Count Taxable Portion
Notes received for services Count Taxable Portion
Nutrition benefits (Supplemental Nutrition Assistance Program, Not Counted
Nutrition Programs for the Elderly or Disabled)
Ordinary/qualified dividends, 1099-DIV Count Taxable Portion
Other earned income, W-2 Count Taxable Portion
Other gains (or losses), Form 4797 Count Taxable Portion
Paid family leave, 1099-G Count Taxable Portion

Pensions, Department of Defense Retirement Board military Count Taxable Portion

retirement, endowment contracts paid as annuities and taxable
annuities, 1099-R
Pension payments that were paid by the employee (such as Not Counted
premiums or contributions) that were previously subject to tax
Physical injury, illness or emotional distress payments Not Counted
Principal payments on loans Not Counted
Prizes and awards Count Taxable Portion

Pulitzer, Nobel or similar prize Count Taxable Portion

Covered California Outreach and Sales Division

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 Public assistance payments, general assistance, Bureau of Not Counted
Indian Affairs general assistance
Qualified tuition program, Pub. 970 Count Taxable Portion

Qualified reservist distribution from health flexible spending Count Taxable Portion
account, W-2, Pub 525
Radiation Exposure Compensation Payment Not Counted
Railroad Retirement benefits (taxable and non-taxable), RRB- Count Gross
1099
Railroad Unemployment benefits, 1099-G Count Taxable Portion
Recoveries of amounts deducted or for which a credit was taking Count Taxable Portion
in an earlier year. Refunds/reimbursements/rebates of itemized
deductions
Reemployment Trade Adjustment Assistance payments made by Count Taxable Portion
a state agency, 1099-G
Refugee cash assistance Not Counted
Refugee reception and replacement program one-time payments Not Counted
by the Dept. of State or Dept. of Justice, such as Voluntary
Agency (VOLAG) payments
Reimbursement for Employment Agency Fee Count Taxable Portion

Reimbursements not in excess of costs incurred Not Counted

Relocation assistance payments Not Counted
Relocation and Rehabilitation payments due to floods under the Not Counted
Housing and Community Development Act
Rental of personal property – not self-employment Count Taxable Portion

Rental real estate, royalties, partnerships, S corporations, trusts, Count Taxable Portion
etc. (or loss), Schedule E
Renter’s tax credit (California) Not Counted
Repayment of bona fide loan not in excess of original loan Not Counted
Replacement Housing payments under the Uniform Relocation Not Counted
Assistance and Real Property Acquisition Act
Reverse Annuity Mortgage Not Counted
Rewards Count Taxable Portion

Ricky Ray Hemophilia Relief Fund Not Counted

Roth IRA, 401K, 403(b), or 457(b) qualified distribution Not Counted
Salary or wages from decedents’ employer (received by a Not Counted
surviving spouse)
Scholarships, awards, fellowship grants NOT used for living Not Counted Count Taxable Portion
expenses, Pub. 970
Scholarships, awards, fellowship grants used for living Count Taxable Portion
expenses, Pub, 970
Self-employment (in excess of expenses), Schedule K-1, Count Taxable Portion
Covered California Outreach and Sales Division
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 Schedule SE
Severance pay, sick pay, vacation, annual leave, and paid Count Taxable Portion
holidays
Social Security benefits (taxable and non-taxable), including Count Gross
Social Security Disability Income (SSDI)SSA-1099
Sponsor’s income given to a sponsored immigrant Not Counted
State Disability Insurance (SDI) - California, that is not paid as a Not Counted
substitute for unemployment insurance benefits
State Disability Insurance (SDI), when paid as a substitute for Count Taxable Portion
unemployment insurance benefits, 1099-G
State tax refund in excess of prior year state tax deducted Count Taxable Portion

Strike and lockout benefits Count Taxable Portion

Supplemental Security Income/State Supplementary Payment Not Counted

(SSI/SSP) program benefits
Surrogacy Count Taxable Portion
Taxable refunds, credits, or offsets of state/local income taxes Count Taxable Portion
Tips Count Taxable Portion
Trade Readjustment Allowance (TRA), 1099-G Count Taxable Portion
Unearned income in-kind/personal expenses paid by another, Count Taxable Portion
including a corporation
Unemployment assistance under the Airline Deregulation Act of Count Taxable Portion
1974 Program, 1099-G
Unemployment assistance under the Disaster Relief and Count Taxable Portion
Emergency Assistance Act of 1974, 1099-G
Unemployment benefits paid by a union Count Taxable Portion

Unemployment compensation (State or Federal), 1099-G Count Taxable Portion

Utility rebates Count Taxable Portion

Veteran’s Administration (VA) aid and attendance benefits paid Not Counted
to the veteran or their families
Veteran’s Administration agent orange benefits Not Counted
Veteran’s Administration benefits for children with certain birth Not Counted
defects
Veteran’s Administration compensated work-therapy program Not Counted
payments
Veteran’s Administration death gratuity paid to a survivor of a Not Counted
member of the Armed Forces who died after
Veteran’s Administration dependent-care assistance program Not Counted
benefits
Veteran’s Administration disability compensation paid either to Not Counted
the veteran or their families
Veteran’s Administration education, training or subsistence Not Counted
allowances

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 Veteran’s Administration grants for homes designed for Not Counted
wheelchair living
Veteran’s Administration grants for motor vehicles for veterans Not Counted
who lost their sight or the use of their limbs
Veteran’s Administration insurance interest left on deposit with Not Counted
the VA
Veteran’s Administration Filipino Veterans Equity Compensation Not Counted
Trust Fund payments
Veteran’s Administration POW/MIA benefits Not Counted
Veteran’s Administration pension benefits paid to the veteran or Not Counted
their families
Veteran’s bonus payment paid by any state or political Not Counted
subdivision because of service in a combat zone
Victims of crimes payments Not Counted
Vocational rehabilitation goods, services and cash received, not Not Counted
in return for services, but for training and rehabilitation due to
disability
Volunteer Work amounts: • Peace Corps living allowances for Not Counted
housing, utilities, household supplies, food and clothing • Nat’l
Senior Service Corps supportive services or reimbursements for
out- of-pocket expenses from the Retired Senior Volunteer
Program (RSVP); Foster Grandparent Program; or Senior
Companion Program • Service Corps of Retired Executives
(SCORE) amounts for supportive services or out-of-pocket
expenses • Volunteer tax counseling reimbursements for
transportation, meals, and other expenses you have in training
for, or actually providing tax counseling for the elderly
Walker v. Bayer payment (class action settlement payment) Not Counted
Weatherization, home energy assistance, emergency repair or Not Counted
replacement of heating/cooling devices
Whistleblower’s award Count Taxable Portion

Withholding from a benefit to repay an overpayment from the Not Counted

same income source
Worker’s Compensation paid to the worker or their survivors Not Counted
Workforce Investment Act payments Not Counted
Work training program payments – entire amount paid by a state Count Taxable Portion
welfare agency if greater than what would otherwise be paid for
public welfare benefits
Work training program payments made by a state welfare Not Counted
agency if the total does not exceed what would have been paid
in public welfare benefits

One-Time Lump Sum Payments

LUMP SUM PAYMENTS; any payment received one time, MAGI Medi-Cal APTC/CSR
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 or any single payment paid retroactively that represents
one or more past payment periods such as any of the [DHCS Note: Do not
following: include in annual
income.]
Cancellation of debt Count in month Count as annual
received income
Education scholarships, awards, fellowship grants not used for Not counted Count Taxable Portion
living expenses
Education scholarships, awards, fellowship grants used for Count in month Count Taxable Portion
living expenses received
Employee accrued vacation, annual leave or sick pay Count taxable amount Count as annual
in the month received income
Employee back pay awarded in a settlement Count in month Count as annual
received income
Gambling winnings Count in month Count as annual
received income
Insurance settlements due to death, personal injury, damage, Not Counted
or loss of property
Lottery winnings Count in month Count as annual
received income
Prizes and awards Count in month Count as annual
received income
Retroactive Social Security and railroad retirement benefits Count in month Count as annual
received income
Retroactive unemployment insurance benefits Count in month Count as annual
received income
Surviving spouse or beneficiary receives salary or wages from Count in month Count as annual
decedent’s employer received income
Surviving spouse or beneficiary receives lump sum qualified Count taxable amount Count taxable amount
retirement plan distribution from decedent’s employer in month received as annual income

Deductions

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 Deductions: One-Time Lump Sum, Annual, or Monthly MAGI Medi-Cal APTC/CSR

Alimony paid Monthly Deduction Annual

Deduction only if the divorce or separation instrument is executed on or (See note) Deduction (See
before 12/31/2018. Not counted as a deduction (nor as taxable income note)
for the recipient) for divorce decrees or separation agreements executed
on or after 01/01/2019.
Certain business expenses of reservists, performing artists, etc. Monthly deduction Annual deduction
Child Care No deduction No deduction
Child support paid No deduction No deduction
Deductible part of self-employment tax Monthly deduction Annual deduction
Domestic production activities deductions Monthly deduction No deduction
No longer deductible as of January 1, 2018
Educator expenses Monthly deduction Annual deduction
Health Savings Account deduction Monthly deduction Annual deduction
IRA deduction Monthly deduction Annual deduction
Moving expenses No Deduction (See No Deduction
• As of January 1, 2018, no longer deductible except for members note) (See note)
of armed service active duty military and moved due to
permanent change of station. [Prior to 1/1/2018 the deduction
was monthly for M/C, annual for APTC/CSR.]
Penalty on early withdrawal of savings Monthly deduction Annual deduction
Self-employed health insurance deduction Monthly deduction Annual deduction
Self-employed SEP, simple, and qualified plans Monthly deduction Annual deduction
Student loan interest deduction Monthly deduction Annual deduction
Tuition and fees No Deduction (See No Deduction
No longer deductible as of January 1, 2018 note) (See note)

AI/AN Income Exceptions

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 Type MAGI Medi-Cal APTC/CSR
Distributions from Alaska Native corporations and settlement trusts Not Counted Count Taxable
Portion
Distributions from any property held in trust, subject to federal Not Counted Count Taxable
restrictions, located within the most recent boundaries of a prior Federal Portion
reservation, or otherwise under the supervision of the Secretary of the
Interior
Distributions and payments from rents, leases, rights of way, royalties, Not Counted Count Taxable
usage rights, or natural resource extraction and harvest from: Portion
Rights of ownership or possession in any lands located within the most
recent boundaries of a prior Federal reservation, or otherwise under the
supervision of the Secretary of the Interior
Federally protected rights regarding off-reservation hunting, fishing,
gathering, or usage of natural resources
Distributions resulting from real property ownership interests related to Not Counted Count Taxable
natural resources and improvements: Portion
Located on or near a reservation or within the most recent boundaries of
a prior Federal reservation; or
Resulting from the exercise of federally-protected rights relating to such
real property ownership interests

Payments resulting from ownership interest in or usage rights to items Not Counted Count Taxable
that have a unique religious, spiritual, traditional, or cultural significance Portion
or rights that support subsistence or a traditional lifestyle according to
applicable Tribal Law or custom
Student financial aid provided under the Bureau of Indian Affairs Not Counted Count Taxable
education programs Portion

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