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. 03/01/23)Family Size194% of Federal Poverty Level194% + 5% of Federal Poverty LevelMonthly IncomeAnnual IncomeMonthly IncomeAnnual Income12,357.1028,285.202,417.8529,014.2023,188.0638,256.803,270.2339,242.8034,019.0348,228.404,122.6149,471.4044,850.0058,200.004,975.0059,700.0055,680.9668,171.605,827.3869,928.6066,511.9378,143.206,679.7680,157.2077,342.9088,114.807,532.1590,385.8088,173.8698,086.408,384.53100,614.40Each Additional Member830.969,971.60882.3810,228.60103.02Partners for Healthy Children(Eff. 03/01/23)Family Size208% of Federal Poverty Level208% + 5% of Federal Poverty LevelMonthly IncomeAnnual IncomeMonthly IncomeAnnual Income12,527.2030,326.402,587.9531,055.4023,418.1341,017.603,500.3042,003.6034,309.0651,708.804,412.6552,951.8045,200.0062,400.005,325.0063,900.0056,090.9373,091.206,237.3574,848.2066,981.8683,782.407,149.7085,796.4077,872.8094,473.608,062.0596,744.6088,763.73105,164.808,974.40107,692.80Each Additional Member890.939,817.60912.3510,948.20103.03Parent/Caretaker Relative (PCR) (formerly Low-Income Families – LIF)(Eff. 03/01/23)Family Size62% of Federal Poverty Level62% + 5% of Federal Poverty LevelMonthly IncomeAnnual IncomeMonthly IncomeAnnual Income1753.309,039.60814.059,768.6021,018.8612,226.401,101.0313,212.4031,284.4315,413.201,388.0116,656.2041,550.0018,600.001,675.0020,100.0051,815.5621,786.801,961.9823,543.8062,081.1324,973.602,248.9626,987.6072,346.7028,160.402,535.9530,431.4082,612.2631,347.202,822.9333,875.20Each Additional Member265.563,186.80286.983,443.80103.03ATransitional Medicaid (TMA) (Eff. 03/01/23)Family Size185% of Federal Poverty LevelMonthly IncomeAnnual Income12,247.7526,973.0023,040.1636,482.0033,832.5845,991.0044,625.0055,500.0055,417.4165,009.0066,209.8374,518.0077,002.2584,027.0087,794.6693,536.00Each Additional Member792.419,509.00103.04Regular Foster Care – RFCSubsidized Adoption(Eff. 03/01/23)Monthly Income LimitMarch 2023$ 814.05Historic Income LimitEffective MonthMonthly Income LimitMarch 2022$ 758.77March 2021$ 719.13March 2020$ 712.43March 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$ 387103.05Aged, Blind and Disabled (ABD), Qualified Medicare Beneficiary (QMB),Specified Low Income Beneficiaries (SLMB),Qualifying Individual (QI)(Eff. 03/01/23)Family SizeABD, QMB100%SLMB120%QI135%MonthlyAnnualMonthlyAnnualMonthlyAnnual1 (Individual)1,21514,580.001,45817,4961,64118,3462 (Couple)1,64419,720.001,97223,6642,21924,718103.06Federal Poverty Level Chart (100% of Federal Poverty Level. Used to calculate eligibility limits for poverty-based programs)(Eff. 03/01/23)Family SizeAnnual114,580.00219,720.00324,860.00430,000.00535,140.00640,280.00745,420.00850,560.00Each Additional Person5,140.00103.07General Hospital (GH), Nursing Home (NH), Katie Beckett (TEFRA), Home and Community Based Services (HCBS)(300% of Federal Benefit Rate)(Eff. 01/01/23)Family SizeMonthly Income LimitIndividual$2,742.00Spousal Allocation (NH and HCBS only)$3,715.50Medicare Part D Premium Benchmark for South Carolina$37.84103.07ACurrent Average Monthly Private Pay Rate(Eff. 01/01/23)Current Average Monthly Private Pay Rate$8,797.11 ($289.22 daily)103.08 Breast and Cervical Cancer Program (BCCP) Qualified Disabled Working Individuals (QDWI)(200% of Federal Poverty Level)(Eff. 03/01/23)FAMILY SIZEMONTHLY INCOMEANNUAL INCOME12,430.0029,160.0023,287.0039,440.0034,144.0049,720.0045,000.0060,000.0055,857.0070,280.0066,714.0080,560.0077,570.0090,840.0088,427.00101,120.00Each Additional Member857.0010,280.00For 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. 03/01/23)Family SizeMonthly IncomeAnnual Income13,038.0036,450.0024,109.0049,300.0035,180.0062,150.0046,250.0075,000.0057,321.0087,850.0068,392.00100,700.0079,463.00113,550.00810,534.00126,400.00Each Additional Member984.0012,850.00If 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$1,215$14,580103.10Optional State Supplementation – OSS(Eff. 01/01/23)Monthly Net Income Limit:$1,699.00Personal Needs Allowance: $79.00(Receives SSI only)$99.00(Receives any income from other sources)103.11Substantial Gainful Activity – SGA(Eff. 01/01/23)Blind Individual$2,460Non–Blind Individual$1,470103.12Student Earned Income Exclusion(Eff. 01/01/23)Per Month Limit$2,220Maximum Annual Limit$8,950103.13Tuberculosis 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. 03/01/23)Family SizeMonthly IncomeAnnual Income11,615.9519,391.4022,185.6326,227.6032,755.3133,063.8043,325.0039,900.0053,894.6846,736.2064,464.3653,572.4075,034.0560,408.6085,603.7367,244.80Each Additional Member569.686,836.20For family sizes over 8, add the amount shown for each additional person to income limit for 8.103.14Program Resource Limits(Eff. 01/01/23)CFR §435.603ProgramIndividual LimitCouple LimitChapter 303ABD, QMB, SLMB$9,090$13,630Chapter 304Nursing Home, HCBS, General Hospital$2,000Home Equity Limit: $688,000$66,480Spousal share for community spouse. Refer to MPPM 304.14Chapter 305 TEFRA$2,000N/AChapter 307 Working Disabled$9,090N/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. 01/01/23)Tax YearYearly Taxable Income2022$12,9502021$12,5502020$12,4002019$12,2002018$10,4002017$10,400103.16Social Security Cost–of–Living Adjustment – COLA and Supplemental Security Income – SSI Federal Benefit Rate (Eff. 01/01/23)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-20238.7%914.00304.67324.671,371.00457.00477.00457.00Jan-20225.9%841.00280.33300.331,261.00420.33440.33420.00Jan-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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