Revision 18-2; Effective June 1, 2018

 

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

Income — Effective Jan. 1, 2018, 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 — $750
  • Couple — $1,125
  • Deeming amount — $375

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 and/or shelter that an individual receives from someone else.

Effective Jan 1, 2018:

  • One-third of the SSI FBR:
    • Individual — $250.00
    • Couple — $375.00
  • One-third of the SSI FBR + 20:
    • Individual — $270.00
    • Couple — $395.00
  • One-half of the couple 1/3 SSI FBR:
    • Companion — $187.50
  • One-half of the couple 1/3 SSI FBR + 10:
    • Companion — $197.50

 

All Living Arrangements

Effective Jan 1, 2018, the special income exemption for a student’s earned income (regardless of living arrangement).

  • Monthly earnings — $1,820
  • Annual earnings — $7,350

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

 

Medicare Savings Programs (MSP)

Income limits are based on the federal poverty income limit (FPIL).

Income — Effective March 1, 2018, total countable income must be:

  • QMB — No more than 100 percent FPIL:
    • Individual — $1,012
    • Couple — $1,372
    • Deeming amount — $360
    • Medicaid benefits are:
      • Part A premiums
      • Part B premiums
      • Deductibles
      • Coinsurance
  • SLMB —Greater than 100 percent FPIL, but less than 120 percent FPIL:
    • Individual — $1,012.01 to < $1,214
    • Couple — $1,372.01 to < $1,646
    • Deeming amount — $432
    • Medicaid benefits are:
      • Part B premiums
  • QI-1 — At least 120 percent FPIL, but less than 135 percent FPIL:
    • Individual — $1,214 to < $1,366
    • Couple — $1,646.01 to < $1,852
    • Deeming amount — $486
    • Medicaid benefits are:
      • Part B premiums
  • QDWI — No more than the 200 percent FPIL:
    • Individual — $2,024
    • Couple — $2,744
    • Deeming amount — $720
    • Medicaid benefits are:
      • Part A premiums

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

Resources — Effective Jan. 1, 2018, total countable resources must be:

  • QMB, SLMB, QI-1 — No more than the limit:
    • Individual — $7,560
    • Couple — $11,340
  • QDWI — No more than twice the SSI resource limit:
    • Individual — $4,000
    • Couple — $6,000

 

Medicaid Buy-In (MBI) Program

Income — Effective March 1, 2018:

  • Income eligibility is based on earnings.
  • Countable earned income must be less than the limit:
    • 250 percent of FPIL — $2,530

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

MBI Monthly Premiums: Countable Unearned Income Minus (−) SSI FBR of $750 Plus (+) Earned Income Premium

Unearned Income Premium
Countable Unearned Income Minus (−) SSI FBR of $750 

Earned Income Premium

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

 

Less than or equal to $1,518

$0

150%–185% of FPIL

Greater than $1,518 up to and including $1,872

$20

>185%–200% of FPIL

Greater than $1,872 up to and including $2,024

$25

>200%–250% of FPIL

Greater than $2,024 up to and including $2,530

$30

>250% of FPIL

Greater than $2,530

$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, 2018:

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

These amounts do not include the MBIC income exclusion.

 
FPIL Amounts for Income Eligibility
Family Size 150% FPIL
1 $1,518
2 $2,058
3 $2,598
4 $3,138
5 $3,678
6 $4,218
7 $4,758
8 $5,298

Ineligible sibling exclusion amount (150% FPIL x 2 + $85) — $3,121

FPIL Amounts for Premium Determination
Family Size 150% FPIL 200% FPIL 300% FPIL
1 $1,518 $2,024 $3,035
2 $2,058 $2,744 $4,115
3 $2,598 $3,464 $5,195
4 $3,138 $4,184 $6,275
5 $3,678 $4,904 $7,355
6 $4,218 $5,624 $8,435
7 $4,758 $6,344 $9,515
8 $5,298 $7,064 $10,595
 
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% FPIL $0 $0
151–200% FPIL

 

$90 $115
201–300% FPIL

 

$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% FPIL $0 $0
151–200% FPIL

 

$25 $35
201–300% FPIL

 

$50 $70

 

MBIC Premiums — ESI and No State-Paid HIPP

No MBIC premium.

Medicare Premiums

Effective Jan. 1, 2018

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.
  • $422 — 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.
  • $232 — 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):

  • $134.00— 2018 standard Medicare Part B monthly premium. (no change from 2017)

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, 2018, total countable income must be no more than the special income limit:

  • Individual — $2,250
  • Couple — $4,500

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, 2018, total countable income must be no more than the special income limit:

  • Individual — $2,250
  • Couple — $4,500

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

  • Individual — $2,000
  • Couple — $3,000
  • Substantial home equity — $572,000
  • Transfer of assets (TOA) divisor — $172.65 daily rate (effective Sept. 1, 2017)

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)
  • Section H-1550, Guardianship Fees — Varies
  • Section H-1600, Dependent Allowance (Non-Spousal) — $750
  • Section H-2000, Incurred Medical Expenses — Varies
  • Section H-1700, Deduction for Home Maintenance — Up to $750

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)
    • $52,250 (HCBS waiver recipient)
  • Section H-1550, Guardianship Fees — Varies
  • Minimum Monthly Maintenance Needs Allowance (MMMNA) (Spousal allowance) — $3,090
  • Section J-7400, Spousal Impoverishment Dependent Allowance — $2,030 (effective July 1, 2017)
  • 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 — $24,720); but
    • SPRA is not to exceed the maximum resource amount set by federal law (SPRA maximum — $123,600).
  • Income-first minimum monthly maintenance needs allowance (MMMNA) for SPRA expansion — $3,090