103 - Program Financial Limits



TOC \o "1-2" \h \z 103.01Family Planning (FP) & Pregnant Women and Infants (PW) PAGEREF _Toc61272321 \h 2103.02Partners for Healthy Children PAGEREF _Toc61272322 \h 2103.03Parent/Caretaker Relative (PCR) (formerly Low Income Families – LIF) PAGEREF _Toc61272323 \h 3103.03ATransitional Medicaid (TMA) PAGEREF _Toc61272324 \h 3103.04Regular Foster Care – RFC Subsidized Adoption PAGEREF _Toc61272325 \h 3103.05Aged, Blind and Disabled (ABD), Qualified Medicare Beneficiary (QMB), Specified Low Income Beneficiaries (SLMB), Qualifying Individual (QI) PAGEREF _Toc61272326 \h 4103.06Federal Poverty Level Chart PAGEREF _Toc61272327 \h 4103.07General Hospital (GH), Nursing Home (NH), Katie Beckett (TEFRA), Home and Community Based Services (HCBS) PAGEREF _Toc61272328 \h 5103.07ACurrent Average Monthly Private Pay Rate PAGEREF _Toc61272329 \h 5103.08 Breast and Cervical Cancer Program (BCCP) Qualified Disabled Working Individuals (QDWI) PAGEREF _Toc61272330 \h 5103.09Working Disabled – WD PAGEREF _Toc61272331 \h 6103.10Optional State Supplementation – OSS PAGEREF _Toc61272332 \h 6103.11Substantial Gainful Activity – SGA PAGEREF _Toc61272333 \h 6103.12Student Earned Income Exclusion PAGEREF _Toc61272334 \h 6103.13Tuberculosis Services – TB PAGEREF _Toc61272335 \h 7103.14Program Resource Limits PAGEREF _Toc61272336 \h 7103.15Federal Income Tax Filing Threshold for Dependents PAGEREF _Toc61272337 \h 8103.16Social Security Cost–of–Living Adjustment – COLA and Supplemental Security Income – SSI Federal Benefit Rate PAGEREF _Toc61272338 \h 8103.01Family Planning (FP) & Pregnant Women and Infants (PW)(Eff. 03/01/21)Family Size194% of Federal Poverty Level194% + 5% of Federal Poverty LevelMonthly IncomeAnnual IncomeMonthly IncomeAnnual Income12,082.2624,987.202,135.9325,631.2022,816.2333,794.802,888.8134,665.8033,550.2042,602.403,641.7043,700.4044,284.1651,410.004,394.5852,735.0055,018.1360,217.605,147.4661,769.6065,752.1069,025.205,900.3570,804.2076,486.0677,832.806,653.2379,838.8087,220.0386,640.407,406.1188,873.40Each Additional Member733.968,807.60752.889,034.60Table of Contents103.02Partners for Healthy Children(Eff. 03/01/21)Family Size208% of Federal Poverty Level208% + 5% of Federal Poverty LevelMonthly IncomeAnnual IncomeMonthly IncomeAnnual Income12,232.5326,790.402,286.2027,434.4023,019.4636,233.603,092.0537,104.6033,806.4045,676.803,897.9046,774.8044,593.3355,120.004,703.7556,445.0055,380.2664,563.205,509.6066,115.2066,167.2074,006.406,315.4575,785.4076,954.1383,449.607,121.3085,455.6087,741.0692,892.807,927.1595,125.80Each Additional Member786.939,443.20805.859,670.20103.03Parent/Caretaker Relative (PCR) (formerly Low-Income Families – LIF)(Eff. 03/01/21)Family Size62% of Federal Poverty Level62% + 5% of Federal Poverty LevelMonthly IncomeAnnual IncomeMonthly IncomeAnnual Income1665.467,985.60719.138,629.602900.0310,800.40972.6111,671.4031,134.6013,615.201226.1014,713.2041,369.1616,430.001479.5817,755.0051,603.7319,244.801733.0620,796.8061,838.3022,059.601986.5523,838.6072,072.8624,874.402240.0326,880.4082,307.4327,689.202493.5129,922.20Each Additional Member234.562,814.80253.483,041.80103.03ATransitional Medicaid (TMA) (Eff. 03/01/21)Family Size185% of Federal Poverty LevelMonthly IncomeAnnual Income11,986.0023,828.0022,686.0032,227.0033,386.0040,626.0044,086.0049,025.0054,786.0057,424.0065,486.0065,823.0076,186.0074,222.0086,886.0082,621.00Each Additional Member700.008,399.00103.04Regular Foster Care – RFCSubsidized Adoption(Eff. 03/01/21)Monthly Income LimitMarch 2021$ 719.13March 2020$ 712.43Historic Income LimitEffective MonthMonthly Income LimitMarch 2019$ 697.35March 2018$ 677.81March 2017$623.10March 2016$ 613.80March 2015$ 608.12March 2014$ 602.95January 2014$ 593.65October 2013$ 479October 2012$ 466November 2011$ 454November 2009$ 452October 2008$ 434October 2007$ 425October 2006$ 408October 2005$ 398October 2004$ 387October 2003$ 374103.05Aged, Blind and Disabled (ABD), Qualified Medicare Beneficiary (QMB),Specified Low Income Beneficiaries (SLMB),Qualifying Individual (QI)(Eff. 03/01/21)Family SizeABD, QMB100%SLMB120%QI135%MonthlyAnnualMonthlyAnnualMonthlyAnnual1 (Individual)1,07412,8801,28815,4561,44917,3882 (Couple)1,45217,4201,74220,9041,96023,517103.06Federal Poverty Level Chart (100% of Federal Poverty Level. Used to calculate eligibility limits for poverty-based programs)(Eff. 03/01/21)Family SizeAnnual112,880217,420321,960426,500531,040635,580740,120844,660Each Additional Person4,540103.07General Hospital (GH), Nursing Home (NH), Katie Beckett (TEFRA), Home and Community Based Services (HCBS)(300% of Federal Benefit Rate)(Eff. 01/01/21)Family SizeMonthly Income LimitIndividual$2,382.00Spousal Allocation (NH and HCBS only)$3,259.50Medicare Part D Premium Benchmark for South Carolina$27.56103.07ACurrent Average Monthly Private Pay Rate(Eff. 01/01/21)Current Average Monthly Private Pay Rate$8,104.52 ($266.45 daily)103.08 Breast and Cervical Cancer Program (BCCP) Qualified Disabled Working Individuals (QDWI)(200% of Federal Poverty Level)(Eff. 03/01/21)FAMILY SIZEMONTHLY INCOMEANNUAL INCOME12,147.0025,760.0022,904.0034,840.0033,660.0043,920.0044,417.0053,000.0055,174.0062,080.0065,930.0071,160.0076,687.0080,240.0087,444.0089,320.00Each Additional Member757.009,080.00For family sizes over 8, add the amount shown for each additional person to income limit for 8.103.09Working Disabled – WD(250% of Federal Poverty Level)(Eff. 03/01/21)Family SizeMonthly IncomeAnnual Income12,684.0032,200.0023,630.0043,550.0034,575.0054,900.0045,521.0066,250.0056,467.0077,600.0067,413.0088,950.0078,359.00100,300.0089,305.00111,650.00Each Additional Member946.0011,350.00If applicant’s household meets income requirement of 250% FPL, it must also be determined whether the applicant has unearned income equal to or less than 100% FPL.Applicant’s Unearned IncomeMonthly IncomeAnnual Income$1,074$12,880103.10Optional State Supplementation – OSS(Eff. 01/01/19)Monthly Net Income Limit:$1,456.00Personal Needs Allowance: $71.00(Receives SSI only)$91.00(Receives any income from other sources)103.11Substantial Gainful Activity – SGA(Eff. 01/01/21)Blind Individual$2,190Non–Blind Individual$1,310103.12Student Earned Income Exclusion(Eff. 01/01/21)Per Month Limit$1,930Maximum Annual Limit$7,770103.13Tuberculosis Services – TB(133% of Federal Poverty Level)The TB Only Program is not a separate Medicaid eligibility category but is an additional benefit added to an existing eligibility category.(Eff. 03/01/21)Family SizeMonthly IncomeAnnual Income11,427.5317,130.4021,930.7123,168.6032,433.9029,206.8042,937.0835,245.0053,440.2641,283.2063,943.4547,321.4074,446.6353,359.6084,949.8159,397.80Each Additional Member503.186,038.20For family sizes over 8, add the amount shown for each additional person to income limit for 8.103.14Program Resource Limits(Eff. 01/01/21)CFR §435.603ProgramIndividual LimitCouple LimitChapter 303ABD, QMB, SLMB$7,970$11,960Chapter 304Nursing Home, HCBS, General Hospital$2,000Home Equity Limit: $603,000$66,480Spousal share for community spouse. Refer to MPPM 304.14Chapter 305 TEFRA$2,000N/AChapter 306 Qualifying Individual (QI)$7,970$11,960Chapter 307 Working Disabled$7,970N/AChapter 308 Qualified Disabled Working Individual$4,000$6,000Chapter 403 Optional State Supplementation$2,000N/AChapter 404Pass–along$2,000$3,000Chapter 405 Retroactive SSI$2,000$3,000103.15Federal Income Tax Filing Threshold for Dependents(Eff. 01/01/21)Tax YearYearly Taxable Income2020$12,4002019$12,2002018$10,4002017$10,400103.16Social Security Cost–of–Living Adjustment – COLA and Supplemental Security Income – SSI Federal Benefit Rate (Eff. 01/01/21)Effective DateCost of Living Adjustment (COLA)IndividualCoupleChild AllocationFederal Benefit Rate (FBR) in Own HouseholdValue of the 1/3 Reduction (VTR)Presumed Maximum Value (PMV)Federal Benefit Rate (FBR) in Own HouseholdValue of the 1/3 Reduction (VTR)Presumed Maximum Value (PMV)Jan-20211.3%794.00264.66284.661,191.00397.00417.00397.00Jan-20201.6%783.00261.00 281.00 1,175.00391.66 411.66 392.00Jan-20192.8%771.00257.00 277.00 1,157.00385.66 405.66 386.00Jan-20182.0%750.00250.00 270.00 1,125.00375.00 395.00 375.00Jan-20170.3%735.00245.00 265.00 1,103.00367.66 387.66 368.00Jan-20151.7%733.00244.33 264.33 1,100.00366.66 386.66 367.00Jan-20141.5%721.00240.33 260.33 1,082.00360.66 380.66 361.00Jan-20131.7%710.00236.66 256.66 1,066.00355.33 375.33 355.00Jan-20123.6%698.00232.66 252.66 1,048.00349.33 369.33 350.00Jan-20095.8%674.00224.66 244.66 1,011.00337.00 357.00 337.00Jan-20082.3%637.00212.33 232.33 956.00318.66 338.66 319.00Jan-20073.3%623.00207.66 227.66 934.00311.33 331.33 311.00Jan-20064.1%603.00201.00 221.00 904.00301.33 321.33 301.00Jan-20052.7%579.00193.00 213.00 869.00290.00 310.00 290.00Jan-20042.1%564.00188.00 208.00 846.00282.00 302.00 282.00Jan-20031.4%552.00184.00 204.00 829.00276.33 296.33 277.00Jan-20022.6%545.00181.66 201.66 817.00272.33 292.33 272.00 ................
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