Yeah, that was my next step.  When you're just over the poverty line, you get into a circular math problem that has no solution.  The best thing to do IMO is to have the client contribute to an IRA (and/or SEP-IRA) until the MAGI is below 400% FPL.  It will literally make them money.  "Here Mr. Taxpayer, move this $500 from your right pocket to your left pocket and now the IRS will give you $3,000.  But if you take the $500 out of your left pocket you have to pay tax on it."

And for folks with good planning skillz, if it's December 15th and you're at 399% of FPL, stop working, it's time for a vacation.