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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
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
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 |
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, 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