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 |
||||
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 |
1575 |
1507 |
382 |
2096 |
1699 |
2265 |
1507 |
2832 |
1133 |
1133 |
1359 |
1529 |
2265 |
57 |
2 |
544 |
2121 |
2030 |
468 |
2823 |
2289 |
3052 |
2030 |
3815 |
1526 |
1526 |
1831 |
2060 |
3052 |
77 |
3 |
678 |
2668 |
2553 |
583 |
3551 |
2879 |
3839 |
2553 |
4798 |
|
|
||||
4 |
797 |
3215 |
3076 |
682 |
4279 |
3469 |
4625 |
3076 |
5782 |
|
|
||||
5 |
912 |
3762 |
3599 |
777 |
5006 |
4059 |
5412 |
3599 |
6765 |
|
|
||||
6 |
1012 |
4308 |
4122 |
857 |
5734 |
4649 |
6199 |
4122 |
7748 |
|
|
||||
7 |
1072 |
4855 |
4646 |
897 |
6462 |
5239 |
6985 |
4646 |
8732 |
|
|
||||
8 |
1132 |
5402 |
5169 |
938 |
7189 |
5829 |
7772 |
5169 |
9715 |
|
|
||||
9 |
1196 |
5949 |
5692 |
982 |
7917 |
6419 |
8559 |
5692 |
10698 |
|
|
||||
10 |
1257 |
6495 |
6215 |
1023 |
8645 |
7009 |
9345 |
6215 |
11682 |
|
|
||||
Social Security – Supplemental Security (SSI) Information
Full SSI for Single living alone: $841.00 (No State Supplement) SSI for Single receiving In-Kind Support: $529.34 (+$3.13 State Supplement) Full SSI for Couple living alone: $1,261.00 (+$4.60 State Supplement) SSI for Couple receiving In-kind Support: $794.00 (+$9.73 State Supplement)
|
|
Dependent Expected to be Required to File Threshold
Earned: $12,550 Unearned: $1,100 Qualifying Relative Limit: $4,200
|
|
Presumed Maximum Value (PMV)
Single: $300.33 Couple: $440.33
|
Nursing Home Personal Needs Allowance
$45 |
Medicare Part B Premium Amounts
$170.10
|
|