Chapter 103 - Program Financial Limits



103.01 Optional Coverage for (Pregnant) Women/Infants – OCWI, Family Planning – FP, Transitional Medicaid (Eff. 03/01/13) 2

103.02 Partners for Healthy Children (Eff. 03/01/13) 2

103.03 Low Income Families – LIF (Eff. 10/01/13) 3

103.04 Regular Foster Care – RFC Subsidized Adoption (Eff. 10/01/13) 3

103.05 Aged, Blind and Disabled – ABD (Eff. 03/01/13) 4

103.06 Specified Low Income Beneficiaries – SLMB Qualifying Individual – QI (Eff. 03/01/13) 4

103.07 General Hospital (GH), Nursing Home (NH), Katie Beckett (TEFRA), Home and Community Based Services (HCBS) (Eff. 01/01/13) 4

103.07A Current Average Monthly Private Pay Rate (Eff. 03/01/12) 4

103.08 Breast and Cervical Cancer Program (BCCP) Qualified Disabled Working Individuals (QDWI) (Eff. 03/01/13) 5

103.09 Working Disabled – WD (Eff. 03/01/13) 5

103.10 Optional State Supplementation – OSS (Eff. 01/01/13) 6

103.11 Substantial Gainful Activity – SGA (Eff. 01/01/13) 6

103.12 Program Resource Limits (Eff. 01/01/13) 7

103.13 Social Security Cost–of–Living Adjustment – COLA and Supplemental Security Income – SSI Federal Benefit Rate (Eff. 01/01/13) 8

103.01 Optional Coverage for (Pregnant) Women/Infants – OCWI,

Family Planning – FP,

Transitional Medicaid (Eff. 03/01/13)

(185% of Federal Poverty Level)

| | | |

|Family Size |Monthly Income |Annual Income |

|1 |$ 1,772.00 |$ 21,264.00 |

|2 |$ 2,392.00 |$ 28,704.00 |

|3 |$ 3,011.00 |$ 36,132.00 |

|4 |$ 3,631.00 |$ 43,572.00 |

|5 |$ 4,251.00 |$ 51,012.00 |

|6 |$ 4,871.00 |$ 58,452.00 |

|7 |$ 5,490.00 |$ 65,880.00 |

|8 |$ 6,110.00 |$ 73,320.00 |

|Each Additional Member |$ 620.00 |$ 7,440.00 |

For family sizes over 8, add the amount shown for each additional person to income limit for 8.

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103.02 Partners for Healthy Children (Eff. 03/01/13)

|Family Size |200% FPL |

|1 |$ 1,915.00 |

|2 |$ 2,585.00 |

|3 |$ 3,255.00 |

|4 |$ 3,925.00 |

|5 |$ 4,595.00 |

|6 |$ 5,265.00 |

|7 |$ 5,935.00 |

|8 |$ 6,605.00 |

|Each Additional Member |$ 670.00 |

For family sizes over 8, add the amount shown for each additional person to income limit for 8.

103.03 Low Income Families – LIF (Eff. 10/01/13)

| |Net Income Limit |

|Number in | |

|Budget Group | |

|1 |$ 479 |

|2 |$ 647 |

|3 |$ 814 |

|4 |$ 982 |

|5 |$ 1,149 |

|6 |$ 1,317 |

|7 |$ 1,484 |

|8 |$ 1,652 |

For family sizes over 8, add $160 for each extra person to net income limit for 8.

103.04 Regular Foster Care – RFC

Subsidized Adoption (Eff. 10/01/13)

| |Monthly Income Limit |

| |$ 479 |

|1 | |

Historic Income Limit

|Effective Month |Monthly Income Limit |

|October 1996 |$ 322 |

|October 1997 |$ 328 |

|October 1998 |$ 335 |

|October 1999 |$ 343 |

|October 2000 |$ 347 |

|October 2001 |$ 357 |

|October 2002 |$ 369 |

|October 2003 |$ 374 |

|October 2004 |$ 387 |

|October 2005 |$ 398 |

|October 2006 |$ 408 |

|October 2007 |$ 425 |

|October 2008 |$ 434 |

|November 2009 |$ 452 |

|November 2011 |$ 454 |

|October 2012 |$ 466 |

103.05 Aged, Blind and Disabled – ABD (Eff. 03/01/13)

(100% of Federal Poverty Level)

|FAMILY SIZE |MONTHLY INCOME |ANNUAL INCOME |

|1 |$958 | $ 11,490 |

|2 |1,293 |$ 15,510 |

103.06 Specified Low Income Beneficiaries – SLMB

Qualifying Individual – QI (Eff. 03/01/13)

(120% and 135% of Federal Poverty Level)

|Family Size |SLMB |QI |

| |120% |135% |

| |$1,149 |$ 1,293 |

|1 (Individual) | | |

| |1,551 |$ 1,745 |

|2 (Couple) | | |

103.07 General Hospital (GH),

Nursing Home (NH),

Katie Beckett (TEFRA),

Home and Community Based Services (HCBS) (Eff. 01/01/13)

(300% of Federal Benefit Rate)

|Family Size |Monthly Income Limit |

|Individual |$ 2,130 |

|Spousal Allocation (NH and HCBS only) |$ 2,898 |

103.07A Current Average Monthly Private Pay Rate (Eff. 03/01/12)

|Current Average Monthly Private Pay Rate |$ 5,644.12 |

103.08 Breast and Cervical Cancer Program (BCCP)

Qualified Disabled Working Individuals (QDWI) (Eff. 03/01/13)

(200% of Federal Poverty Level)

| | | |

|FAMILY SIZE |MONTHLY INCOME |ANNUAL INCOME |

|1 |$ 1,915.00 |$ 22,980.00 |

|2 |$ 2,585.00 |$ 31,020.00 |

|3 |$ 3,255.00 |$ 39,060.00 |

|4 |$ 3,925.00 |$ 47,100.00 |

|5 |$ 4,595.00 |$ 55,140.00 |

|6 |$ 5,265.00 |$ 63,180.00 |

|7 |$ 5,935.00 |$ 71,220.00 |

|8 |$ 6,605.00 |$ 79,260.00 |

|Each Additional Member |$ 670.00 |$ 8,040.00 |

For family sizes over 8, add the amount shown for each additional person to income limit for 8.

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103.09 Working Disabled – WD (Eff. 03/01/13)

(250% of Federal Poverty Level)

| | | |

|Family Size |Monthly Income |Annual Income |

|1 |$ 2,394.00 |$ 28,728.00 |

|2 |$ 3,232.00 |$ 38,784.00 |

|3 |$ 4,069.00 |$ 48,828.00 |

|4 |$ 4,907.00 |$ 58,884.00 |

|5 |$ 5,744.00 |$ 68,928.00 |

|6 |$ 6,582.00 |$ 78,984.00 |

|7 |$ 7,419.00 |$ 89,028.00 |

|8 |$ 8,257.00 |$ 99,084.00 |

|Each Additional Member |$ 838.00 |$ 10,056.00 |

For family sizes over 8, add the amount shown for each additional person to income limit for 8.

103.10 Optional State Supplementation – OSS (Eff. 01/01/13)

| |

|Monthly Net Income Limit: $ 1,193 |

| |

|Personal Needs Allowance: $61 |

|(+ $20 income disregard if applicable) |

103.11 Substantial Gainful Activity – SGA (Eff. 01/01/13)

|Blind Individual |$1,740 |

|Non–Blind Individual |$1,040 |

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103.12 Program Resource Limits (Eff. 01/01/13)

|Program |Individual Limit |Couple Limit |

|Chapter 203 |$30,000 per Budget Group |

|Optional Coverage for (Pregnant) Women and Infants | |

|(OCWI) | |

|Chapter 204 |$30,000 per Budget Group |

|Partners for Healthy Children (PHC) | |

|Chapter 205 |$30,000 per Budget Group |

|Low Income Families (LIF) | |

|Refugee Assistance Program (RAP) | |

|Chapter 207 |$30,000 per Budget Group |

|Children Under Age 21 in Special Living | |

|Arrangements | |

|Chapter 303 |$7,080 |$10,620 |

|ABD, QMB, SLMB | | |

|Chapter 304 |$2,000 |$66,480 |

|Nursing Home, HCBS, General Hospital | |Spousal share for community spouse. Refer to |

| | |MPPM 304.14 |

|Chapter 305 TEFRA |$2,000 |N/A |

|Chapter 306 |$7,080 |$10,620 |

|Qualifying Individual (QI) | | |

|Chapter 307 Working Disabled |$7,080 |N/A |

|Chapter 308 Qualified Disabled Working Individual |$4,000 |$6,000 |

|Chapter 403 Optional State Supplementation |$2,000 |N/A |

|Chapter 404 |$2,000 |$3,000 |

|Pass–along | | |

|Chapter 405 Retroactive SSI |$2,000 |$3,000 |

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103.13 Social Security Cost–of–Living Adjustment – COLA and Supplemental Security Income – SSI Federal Benefit Rate (Eff. 01/01/13)

|EFFECTIVE

DATE |01/03 |01/04 |01/05 |01/06 |01/07 |01/08 |01/09 |01/12 |01/13 | | |

COST–OF–LIVING ADJUSTMENT

(COLA) |

1.4% |

2.1% |

2.7% |

4.1% |

3.3% |

2.3% |

5.8% |

3.6% |

1.7% | |

INDIVIDUAL |

FEDERAL BENEFIT RATE (FBR) IN OWN HOUSEHOLD |

552.00 |

564.00 |

579.00 |

603.00 |

623.00 |

637.00 |

674.00 |

698.00 |

710.00 | | |

VALUE OF THE 1/3 REDUCTION (VTR) |

184.00 |

188.00 |

193.00 |

201.00 |

207.66 |

212.33 |

224.66 |

232.66 |

236.66 | | |

HOUSEHOLD OF ANOTHER |

368.00 |

376.00 |

386.00 |

402.00 |

415.34 |

424.67 |

449.34 |

465.34 |

473.34 | |

COUPLE |

FBR IN OWN HOUSEHOLD |

829.00 |

846.00 |

869.00 |

904.00 |

934.00 |

956.00 |

1,011.00 |

1,048.00 |

1,066.00 | | |

VTR

|

276.33 |

282.00 |

290.00 |

301.33 |

311.33 |

318.66 |

337.00 |

349.33 |

355.33 | | |

HOUSEHOLD OF ANOTHER |

552.67 |

564.00 |

579.00 |

602.67 |

622.67 |

637.34 |

674.00 |

698.67 |

710.67 | |

INELIGIBLE CHILD |

ALLOCATION

|

277.00 |

282.00 |

290.00 |

301.00 |

311.00 |

319.00 |

337.00 |

350.00 |

355.00 | |

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Social Security Cost–of–Living Adjustment – COLA and

Supplemental Security Income – SSI Federal Benefit Rate

with Effective Dates: 01/93 through 01/02

continued on next page.

|EFFECTIVE

DATE |01/93 |01/94 |01/95 |01/96 |01/97 |01/98 |01/99 |01/00 |01/02 | | |

COST–OF–LIVING ADJUSTMENT

(COLA) |

3.0% |

2.6% |

2.8% |

2.6% |

2.9% |

2.1% |

1.3% |

2.5% |

2.6% | |

INDIVIDUAL |

FEDERAL BENEFIT RATE (FBR) IN OWN HOUSEHOLD |

434.00 |

446.00 |

458.00 |

470.00 |

484.00 |

494.00 |

500.00 |

513.00 |

545.00 | | |

VALUE OF THE 1/3 REDUCTION (VTR) |

144.66 |

148.66 |

152.66 |

156.66 |

161.33 |

164.66 |

166.66 |

171.00 |

181.66 | | |

HOUSEHOLD OF ANOTHER |

289.34 |

297.34 |

305.34 |

313.34 |

322.67 |

329.34 |

333.34 |

342.00 |

363.34 | |

COUPLE |

FBR IN OWN HOUSEHOLD |

652.00 |

669.00 |

687.00 |

705.00 |

726.00 |

741.00 |

751.00 |

769.00 |

817.00 | | |

VTR |

217.33 |

223.00 |

229.00 |

235.00 |

242.00 |

247.00 |

250.33 |

256.33 |

272.33 | | |

HOUSEHOLD OF ANOTHER |

434.67 |

446.00 |

458.00 |

470.00 |

484.00 |

494.00 |

500.67 |

512.67 |

544.67 | |

INELIGIBLE CHILD |

ALLOCATION |

218.00 |

223.00 |

229.00 |

235.00 |

242.00 |

247.00 |

251.00 |

256.00 |

272.00 | |

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