Medicaid Policy
HH Size |
PCR |
Pregnant Woman & CM 0-5 |
CM 6-18 |
Med. Family Needy & Refugee
|
12 Month TR |
CHIP Plan B |
CHIP Plan C & UPP |
Adult Expansion |
ABD |
Medicare Cost Sharing |
TAM |
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MWI |
Med Needy |
QMB |
SLMB |
QI-1 |
QDWI |
||||||||||
|
|
139% FPL |
133% FPL |
BMS Level |
185% FPL |
150% FPL |
200% FPL |
133% FPL |
250% FPL |
100% FPL |
100% FPL |
120% FPL |
135% FPL |
200% FPL |
5% FPL |
1 |
438 |
1479 |
1415 |
382 |
1968 |
1595 |
2127 |
1415 |
2659 |
1064 |
1064 |
1276 |
1436 |
2127 |
54 |
2 |
544 |
1997 |
1911 |
468 |
2658 |
2155 |
2874 |
1911 |
3592 |
1437 |
1437 |
1724 |
1940 |
2874 |
72 |
3 |
678 |
2516 |
2408 |
583 |
3349 |
2715 |
3620 |
2408 |
4525 |
|
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4 |
797 |
3035 |
2904 |
682 |
4040 |
3275 |
4367 |
2904 |
5459 |
|
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5 |
912 |
3554 |
3401 |
777 |
4730 |
3835 |
5114 |
3401 |
6392 |
|
|||||
6 |
1012 |
4073 |
3897 |
857 |
5421 |
4395 |
5860 |
3897 |
7325 |
|
|||||
7 |
1072 |
4592 |
4394 |
897 |
6112 |
4955 |
6607 |
4394 |
8259 |
|
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8 |
1132 |
5111 |
4890 |
938 |
6802 |
5515 |
7354 |
4890 |
9192 |
|
|||||
9 |
1196 |
5630 |
5387 |
982 |
7493 |
6075 |
8100 |
5387 |
10,125 |
|
|||||
10 |
1257 |
6149 |
5884 |
1023 |
8184 |
6635 |
8847 |
5884 |
11,059 |
|
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Social Security – Supplemental Security (SSI) Information
Full SSI for Single living alone: $783.00 (No State Supplement) SSI for Single receiving In-Kind Support: $522.00 (+$3.13 State Supplement) Full SSI for Couple living alone: $1,175.00 (+$4.60 State Supplement) SSI for Couple receiving In-kind Support: $783.34 (+$9.73 State Supplement)
|
|
Dependent Expected to be Required to File Threshold
Earned: $12,200 Unearned: $1,100 Qualifying Relative Limit: $4,200
|
|
Presumed Maximum Value (PMV)
Single: $281 Couple: $411.66
|
Nursing Home Personal Needs Allowance
$45 |
Medicare Part B Premium Amounts
$144.60
|
|