Appendix XXXI, Budget Reference Chart

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Revision 21-1; Effective March 1, 2021

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

Income — Effective Jan. 1, 2021, 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 — $794
• Couple — $1,191
• Deeming amount — $397

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, 2021:

• One-third of the SSI FBR:
  • Individual — $264.66
  • Couple — $397
• One-third of the SSI FBR + 20:
  • Individual — $284.66
  • Couple — $417
• One-half of the couple 1/3 SSI FBR:
  • Companion — $198.50
• One-half of the couple 1/3 SSI FBR + 10:
  • Companion — $208.50

All Living Arrangements

Effective Jan. 1, 2021, the special income exemption for a student’s earned income (regardless of living arrangement).

• Monthly earnings — $1,930
• Annual earnings — $7,770

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, 2021, total countable resources must be:

• QMB, SLMB, QI-1 — No more than the limit:
  • Individual — $7,970
  • Couple — $11,960
• 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 $794 Plus (+) Earned Income Premium

Unearned Income Premium
Countable Unearned Income Minus (−) SSI FBR of $794

Earned Income Premium

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.

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

MBIC Premiums — ESI and No State-Paid HIPP

No MBIC premium.

Medicare Premiums

Effective Jan. 1, 2021

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.
• $471 — 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.
• $259 — 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):

• $148.50 — 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, 2021, total countable income must be no more than the special income limit:

• Individual — $2,382
• Couple — $4,764

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, 2021, total countable income must be no more than the special income limit:

• Individual — $2,382
• Couple — $4,764

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

• Individual — $2,000
• Couple — $3,000
• Substantial home equity — $603,000.00
• 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)
  • $2,382 (HCBS waiver recipient) 
• Section H-1550, Guardianship Fees — Varies
• Section H-1600, Dependent Allowance — $794
• Section H-2000, Incurred Medical Expenses — Varies
• Section H-1700, Deduction for Home Maintenance — Up to $794

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)
  • $2,382 (HCBS waiver recipient)
• Section H-1550, Guardianship Fees — Varies
• Minimum Monthly Maintenance Needs Allowance (MMMNA) (Spousal allowance) — $3,259.50
• 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 — $26,076.00); but
  • SPRA is not to exceed the maximum resource amount set by federal law (SPRA maximum — $130,380.00).

Income-first minimum monthly maintenance needs allowance (MMMNA) for SPRA expansion (Spousal Allowance) — $3,259.50