Appendix XXXI, Budget Reference Chart

Revision 20-3; Effective September 1, 2020

 

Community-Based Programs Using SSI Limits (DAC, Pickle, Widow (er) s)

Income — Effective Jan. 1, 2020, total countable income must be less than the Supplemental Security Income (SSI) federal benefit rate (FBR) with the exclusion of certain increases in Social Security benefits:

  • Individual — $783
  • Couple — $1,175
  • Deeming amount — $392

Resources — Total countable resources must be no more than the limit:

  • Individual — $2,000
  • Couple — $3,000
  • Companion — $3,000

 

In-Kind Support and Maintenance (Community Living Arrangement)

The value of food, shelter or both that a person receives from someone else.

Effective Jan. 1, 2020:

  • One-third of the SSI FBR:
    • Individual — $261.00
    • Couple — $391.66
  • One-third of the SSI FBR + 20:
    • Individual — $281.00
    • Couple — $411.66
  • One-half of the couple 1/3 SSI FBR:
    • Companion — $195.83
  • One-half of the couple 1/3 SSI FBR + 10:
    • Companion — $205.83

 

All Living Arrangements

Effective Jan. 1, 2020, the special income exemption for a student’s earned income (regardless of living arrangement).

  • Monthly earnings — $1,900
  • Annual earnings — $7,670

For additional information, see Section E-2220, Student Earnings.

 

Medicare Savings Programs (MSP)

Income limits are based on the federal poverty level (FPL).

Income — Effective March 1, 2020, total countable income must be:

  • QMB — Not more than 100 percent FPL:
    • Individual — $1,064
    • Couple — $1,437
    • Deeming amount — $373
    • Medicaid benefits are:
      • Part A premiums
      • Part B premiums
      • Deductibles
      • Coinsurance
  • SLMB — Greater than 100 percent FPL, but less than 120 percent FPL:
    • Individual — $1,064.01 to < $1,276
    • Couple — $1,437.01 to < $1,724
    • Deeming amount — $448
    • Medicaid benefits are:
      • Part B premiums
  • QI-1 — At least 120 percent FPL, but less than 135 percent FPL:
    • Individual — $1,276 to < $1,436
    • Couple — $1,724 to < $1,940
    • Deeming amount — $504
    • Medicaid benefits are:
      • Part B premiums
  • QDWI — No more than 200 percent FPL:
    • Individual — $2,127
    • Couple — $2,874
    • Deeming amount — $747
    • Medicaid benefits are:
      • Part A premiums

Note: These income limits do not include the $20 disregard for MSP.

Resources — Effective Jan. 1, 2020, total countable resources must be:

  • QMB, SLMB, QI-1 — No more than the limit:
    • Individual — $7,860
    • Couple — $11,800
  • QDWI — No more than twice the SSI resource limit:
    • Individual — $4,000
    • Couple — $6,000

 

Medicaid Buy-In (MBI) Program

Income — Effective March 1, 2020:

  • Income eligibility is based on earnings.
  • Countable earned income must be less than the limit:
    • 250 percent of FPL — $2,659

Resources — Total countable resources must be no more than the limit of $2,000.

MBI Monthly Premiums: Countable Unearned Income Minus (−) SSI FBR of $783 Plus (+) Earned Income Premium

Unearned Income Premium
Countable Unearned Income Minus (−) SSI FBR of $783

Earned Income Premium

Countable Earned Income Based on FPL Range
FPL Dollar Range Earned Income Premium

 

Less than or equal to $1,595

$0

150%–185% of FPL

Greater than $1,595 up to and including $1,968

$20

>185%–200% of FPL

Greater than $1,968 up to and including $2,127

$25

>200%–250% of FPL

Greater than $2,127 up to and including $2,659

$30

>250% of FPL

Greater than $2,659

$40

If the unearned income premium amount plus the earned income premium amount equals or exceeds $500, then the total monthly premium remains at $500.

 

Medicaid Buy-In for Children (MBIC) Program

Resources — No resource test for MBIC.

Income — Effective March 1, 2020:

  • MBIC income exclusion — $85 plus one-half of the remaining income.
  • Eligibility — No more than 150 percent FPL based on family size.

These amounts do not include the MBIC income exclusion.

 
FPL Amounts for Income Eligibility
Family Size 150% FPL
1 $1,595
2 $2,155
3 $2,715
4 $3,275
5 $3,835
6 $4,395
7 $4,955
8 $5,515

Ineligible sibling exclusion amount (150% FPL x 2 + $85) — $3,275

FPL Amounts for Premium Determination
Family Size 150% FPL 200% FPL 300% FPL
1 $1,595 $2,127 $3,190
2 $2,155 $2,874 $4,310
3 $2,715 $3,620 $5,430
4 $3,275 $4,367 $6,550
5 $3,835 $5,114 $7,670
6 $4,395 $5,860 $8,790
7 $4,955 $6,607 $9,910
8 $5,515 $7,354 $11,030
 
MBIC Premiums — No Employer-Sponsored Insurance (ESI)
Family Income Family of 1 or 2 Premium Amount Family of 3 or More Premium Amount
At or below 150% FPL $0 $0
151–200% FPL

 

 $90 $115
201–300% FPL

 

 $180 $230

 

MBIC Premiums — ESI with State-Paid Health Insurance Premium Program (HIPP)
Family Income Family of 1 or 2 Premium Amount Family of 3 or More Premium Amount
At or below 150% FPL $0 $0
151–200% FPL

 

 $25 $35
201–300% FPL

 

 $50 $70

 

MBIC Premiums — ESI and No State-Paid HIPP

No MBIC premium.

 

Medicare Premiums

Effective Jan. 1, 2020

Part A Premium (Hospital Insurance):

  • $0 — Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
  • $458 — Standard Medicare Part A monthly premium cost — The monthly Part A premium for people who are not otherwise eligible for premium-free hospital insurance and who have less than 30 quarters of Medicare-covered employment.
  • $252 — Reduced Medicare Part A premium — The monthly Part A premium for people who have 30–39 quarters of Medicare-covered employment.

Part B Premium (Medical Insurance):

  • $144.60 — 2020 standard Medicare Part B monthly premium.

Staff must use the Medicare Part B amount as verified in the State Online Query (SOLQ). For more information, see Section H-1800, Medicare Part B Premium.

 

Community Attendant Services (CAS)

Income — Effective Jan. 1, 2020, total countable income must be no more than the special income limit:

  • Individual — $2,349
  • Couple — $4,698

Resources — Total countable resources must be no more than the limit:

  • Individual — $2,000
  • Couple — $3,000


Institutional Living Arrangement (Individuals residing in a Medicaid certified long-term care facility or receiving Home and Community Based Waiver services)

Individual or Couple Eligibility Budget

Special income limit — The special income limit for an individual is equal to or less than 300% of the SSI federal benefit rate.

Income — Effective Jan. 1, 2020, total countable income must be no more than the special income limit:

  • Individual — $2,349
  • Couple — $4,698

Resources —Total countable resources must be no more than the limit:

  • Individual — $2,000
  • Couple — $3,000
  • Substantial home equity — $595,000.00
  • Transfer of assets (TOA) divisor — $213.71 daily rate (effective Sept. 1, 2019)

Note: The Transfer of Assets daily rate is reviewed every other year.

Co-Payment

Individual or Couple Co-Payment Budget:

  • Section H-1500, Personal Needs Allowance (PNA) —
    • $60 (nursing facility recipient)
    • $60 plus the Protected Earned Income (PEI) amount (recipient in an ICF/IID facility)
    • $85 (recipient in foster care or assisted living)
    • $2,349 (HCBS waiver recipient) 
  • Section H-1550, Guardianship Fees — Varies
  • Section H-1600, Dependent Allowance (Non-Spousal) — $783
  • Section H-2000, Incurred Medical Expenses — Varies
  • Section H-1700, Deduction for Home Maintenance — Up to $783

Spousal Co-payment Budget:

  • Section H-1500, Personal Needs Allowance (PNA) —
    • $60 (nursing facility recipient)
    • $60 plus the Protected Earned Income (PEI) amount (recipient in an ICF/IID facility)
    • $85 (recipient in foster care or assisted living)
    • $2,349 (HCBS waiver recipient)
  • Section H-1550, Guardianship Fees — Varies
  • Minimum Monthly Maintenance Needs Allowance (MMMNA) (Spousal allowance) — $3,216
  • Section J-7400, Spousal Impoverishment Dependent Allowance — $2,155 (effective July 1, 2020)
  • Section H-2000, Incurred Medical Expenses — Varies

Calculation of the Spousal Protected Resource Amount (SPRA):

  • SPRA is the greater of:
    • one-half of the couple's combined countable resources; or
    • the minimum resource amount set by federal law (SPRA minimum — $25,728.00); but
    • SPRA is not to exceed the maximum resource amount set by federal law (SPRA maximum — $128,640.00).

Income-first minimum monthly maintenance needs allowance (MMMNA) for SPRA expansion (Spousal Allowance) — $3,216