ADDENDUM 1 Program Standards

ADDENDUM 1

PROGRAM STANDARDS

Refer to APA Adult Public Assistance Addendum 1 for APA Adult Public Assistance Need/Payment Stan dards and Supplemental Security Income Eligibility/Payment Standards.

Year 1/1/2023 1/1/2024 1/1/2025 1/1/2026 Special Long Term Care Income Standard $2,742 $2,829 $2,901 $2,982 Alaska NH Nursing Home Personal Needs Allowance $200 $200 $200 $200 Alaska HCB Personal Needs Allowance $1,656 $1,656 $1,656 $1,656 Alaska ALH Assisted Living Home Personal Needs Allowance $1,396 $1,396 $1,396 $1,396 Maximum Community Spouse Resource Allowance $148,620 $154,140 $157,920 $162,660 Community Spouse Monthly Maintenance Need Standard $3,715.50 $3,853.50 $3,948 $4,066.50 Monthly Need Standard for Additional Household Members $1,238.80 $1,284.50 $1,316 $1,355.50

EXPANDED REFUSED CASH INCOME LIMITS HOUSEHOLD TYPE 1/01/2024 01/01/2025 01/01/2026 A Individual (A1E) $1,751 $1,795 $1,845 B Individual (B1E) $1,751 $1,795 $1,845 ALH Individual (H1E) $1,751 $1,795 $1,845 A Couple, 1 Eligible (A2S) $2,593 $2,658 $2,732 B Couple, 1 Eligible (B2S) $2,593 $2,658 $2,732 ALH Couple, 1 Eligible (H2S) $2,593 $2,658 $2,732 A Couple, Both Eligible (A2C) $2,593 $2,658 $2,732 B Couple, Both Eligible (B2C) $2,593 $2,658 $2,732 ALH Couple, Both Eligible (H2C) $2,593 $2,658 $2,732 Nursing Home Regular (NHR) $1,751 $1,795 $1,845

Effective 4/1/2026 Monthly Federal Poverty Guidelines for Alaska Annual Federal Poverty Guidelines for Alaska HH Size QMB Qualified Medicare Beneficiaries Qualified Medicare Beneficiaries SLMB Specified Low Income Medicare Beneficiaries Special Low Income Medicare Beneficiaries Base SLMB Plus Specified Low Income Medicare Beneficiary Plus QDWI Qualified Disabled and Working Individuals Qualified Disabled and Working Individuals Working Disabled Low-Income Subsidy ( LIS Low Income Subsidy ) 100% 120% 135% 200% 250% 135% 140% 145% 149% 150% 1 $1,663 $1,955 $2,245 $3,325 $4,157 $26,933 $27,930 $28,928 $29,726 $29,925 2 $2,255 $2,705 $3,044 $4,509 $5,636 $36,518 $37,870 $39,223 $40,305 $40,575 3 $7,115 $46,103 $47,810 $49,518 $50,884 $51,225 4 $8,594 $55,688 $57,750 $59,813 $61,463 $61,875 5 $10,073 $65,273 $67,690 $70,108 $72,042 $72,525 6 $11,553 $74,858 $77,630 $80,403 $82,621 $83,175 7 $13,032 $84,443 $87,570 $90,698 $93,200 $93,825 8 $14,511 $94,028 $97,510 $100,993 $103,779 $104,475 Addl. $1,480 $9,585 $9,940 $10,295 $10,579 $10,650

Note: The QMB Qualified Medicare Beneficiaries , SLMB Specified Low Income Medicare Beneficiaries 's, and QDWI Qualified Disabled and Working Individuals eligibility categories follow APA Adult Public Assistance / SSI Supplemental Security Income policy, which recognizes only one and two-person households. The Working Disabled Medicaid Buy-In and the LIS Low Income Subsidy categories use the entire household size to determine the 250% standard.

MEDICARE PART A MONTHLY PREMIUM MEDICARE PART B MONTHLY PREMIUM BEFORE 2023 Year 2024 2025 2026 Year 2021 2022 2023 <30 Qtrs $505 $518 $565 $148.50 $170.10 $164.90 >30 -<39 Qtrs $278 $285 $311 QMB, SLMB, & SLMB+ RESOURCE LIMITS MEDICARE PART B MONTHLY PREMIUM STARTING IN 2023 Year 2024 2025 2026 Year 2024 2025 2026 Individual $9,430 $9,660 $9,950 $174.70 $185.00 $202.90 Couple $14,130 $14,470 $14,910 EXCESS HOME EQUITY MEDICARE PART D MAXIMUM LOW INCOME SUBSIDY AMOUNT FOR ALASKA YEAR 2024 2025 2026 Year 2024 2025 2026 $713,000 $730,000 $752,000 $38.76 $38.85 $0.00

Pickle Amendment Table

If SSI Supplemental Security Income was terminated during this period: Multiply 2026 Social Security income by: If SSI Supplemental Security Income was terminated during this period: Multiply 2026 Social Security income by: If SSI was terminated during this period: Multiply 2026 Social Security income by: May – June 1977 .181 Jan. 1993 – Dec. 1993 .437 Jan. 2009 – Dec. 2011 .678 July 1977 – June 1978 .192 Jan. 1994 – Dec. 1994 .449 Jan. 2012 – Dec. 2012 .703 July 1978 – June 1979 .204 Jan. 1995 – Dec. 1995 .461 Jan. 2013 – Dec. 2013 .715 July 1979 – June 1980 .224 Jan. 1996 – Dec. 1996 .473 Jan. 2014 – Dec. 2014 .726 July 1980 – June 1981 .256 Jan. 1997 – Dec. 1997 .487 Jan. 2015 – Dec. 2016 .738 July 1981 – June 1982 .285 Jan. 1998 – Dec. 1998 .497 Jan. 2017 – Dec. 2017 .740 July 1982 – Dec. 1983 .306 Jan. 1999 – Dec. 1999 .504 Jan. 2018 – Dec. 2018 .755 Jan. 1984 – Dec. 1984 .317 Jan. 2000 – Dec. 2000 .516 Jan. 2019 – Dec. 2019 .776 Jan. 1985 – Dec. 1985 .328 Jan. 2001 – Dec. 2001 .534 Jan. 2020 – Dec. 2020 .788 Jan. 1986 – Dec. 1986 .338 Jan. 2002 – Dec. 2002 .548 Jan. 2021 – Dec. 2021 .799 Jan. 1987 – Dec. 1987 .342 Jan. 2003 – Dec. 2003 .556 Jan. 2022 – Dec. 2022 .846 Jan. 1988 – Dec. 1988 .357 Jan. 2004 – Dec. 2004 .568 Jan. 2023 – Dec. 2023 .920 Jan. 1989 – Dec. 1989 .371 Jan. 2005 – Dec. 2005 .583 Jan. 2024 – Dec. 2024 .949 Jan. 1990 – Dec. 1990 .388 Jan. 2006 – Dec. 2006 .607 Jan. 2025 - Dec. 2025 .973 Jan. 1991 – Dec. 1991 .409 Jan. 2007 – Dec. 2007 .627 Jan. 1992 – Dec. 1992 .425 Jan. 2008 – Dec. 2008 .641

Due to the recession, there was no cost of living adjustment in Social Security or SSI Supplemental Security Income benefits in January 2010 or 2011. The cost of living increased by 3.6% effective January 2012. Because of this history, the Pickle reduction factor is the same for individuals who lost SSI Supplemental Security Income benefits in 2009-2011. Due to there being no increase in the Consumer Price Index during federal fiscal year 2015, there was no COLA Cost of Living Allowance adjustment for January of 2016. The Pickle reduction factor is the same for individuals who lost SSI Supplemental Security Income benefits in 2015-2016.

Note: If the last month in which an applicant received SSI Supplemental Security Income while, or immediately before, receiving Social Security was in any of the periods above, multiply the present year amount of the Social Security by the corresponding years reduction factor.

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