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All Medicaid Programs |
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Obsolete Policy |
Previous Table
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HH SIZE |
MAGI |
NON-MAGI |
MAGI-CHIP/UPP |
NON-MAGI |
MEDICARE COST-SHARING |
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PCR |
PREGNANT WOMAN, CHILD 0-5 |
CHILD 6-18 |
Medically Needy Family- related; REFUGEE |
PCR - 12 Month TRANSI-TIONAL |
CHIP PLAN B |
CHIP PLAN C UPP |
AM & DM; Med Needy ABD/PCN |
MWI |
QMB |
SLMB |
QI-1 |
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139% FPL |
133% FPL |
BMS Level |
185% FPL |
150% FPL |
200% FPL |
100% FPL |
250% FPL |
100% FPL |
120% FPL |
135% FPL |
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1 |
438 |
1332 |
1274 |
382 |
1772 |
1437 |
1915 |
958 |
2394 |
958 |
1149 |
1293 |
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2 |
544 |
1797 |
1720 |
468 |
2392 |
1939 |
2585 |
1293 |
3232 |
1293 |
1551 |
1745 |
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3 |
678 |
2263 |
2165 |
583 |
3011 |
2442 |
3255 |
1628 |
4069 |
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4 |
797 |
2729 |
2611 |
682 |
3631 |
2944 |
3925 |
1963 |
4907 |
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5 |
912 |
3194 |
3056 |
777 |
4251 |
3447 |
4595 |
2298 |
5744 |
PMV (Presumed Maximum Value): Single: $260.33 Couple: $380.66 NH Personal Needs Allowance: $45.00 Medicare Part B: $104.90 per month 1619B Income Limit: $2794.00/mo.
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6 |
1012 |
3660 |
3502 |
857 |
4871 |
3949 |
5265 |
2633 |
6582 |
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7 |
1072 |
4125 |
3947 |
897 |
5490 |
4452 |
5935 |
2968 |
7419 |
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8 |
1132 |
4591 |
4393 |
938 |
6110 |
4954 |
6605 |
3303 |
8257 |
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9 |
1196 |
5057 |
4838 |
982 |
6730 |
5457 |
7275 |
3638 |
9094 |
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10 |
1257 |
5522 |
5284 |
1023 |
7350 |
5959 |
7945 |
3973 |
9932 |
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SOCIAL SECURITY/SUPPLEMENTAL SECURITY INCOME (SSI) Information Full SSI for Single living alone: $721.00 (No State Suppl) SSI for Single receiving In-Kind Support: $480.67 (+$3.13 State Suppl) Full SSI for Couple living alone: $1,082.00 (+$4.60 State Suppl) SSI for Couple receiving In-kind Support: $721.34 (+$9.73 State Suppl) |
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