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MEDICAID ELIGIBILITY MANUAL Revised 03/01/2021 1/1/2020 3/1/2020 1/1/2021 3/1/2021 Part A $458.00 N/A $471.00 N/A Part B $144.60 N/A $148.50 N/A SSI Individual FBR Own Household (LA-A) $783.00 N/A $794.00 N/A Title XIX Facility (LA-D) $30.00 N/A $30.00 N/A SSI Couple FBR Own Household (LA-A) $1,175.00 N/A $1,191.00 N/A Deeming Allocation-Ineligible Child $392.00 N/A $397.00 N/A Presumed Maximum Value (PMV) Individual $281.00 N/A $284.66 N/A Couple $411.66 N/A $417.00 N/A SSI RESOURCE LIMITS Individual $2,000.00 N/A $2,000.00 N/A Couple $3,000.00 N/A $3,000.00 N/A Individual $4,000.00 N/A $4,000.00 N/A Couple $6,000.00 N/A $6,000.00 N/A Individual $24,000.00 N/A $24,000.00 N/A Couple $26,000.00 N/A $26,000.00 N/A Individual N/A $1,064.00 N/A $1,074.00 Couple N/A $1,437.00 N/A $1,452.00 Individual N/A $1,436.00 N/A $1,449.00 Couple N/A $1,940.00 N/A $1,960.00 Individual N/A $1,276.00 N/A $1,288.00 Couple N/A $1,724.00 N/A $1,742.00 Individual N/A $1,436.00 N/A $1,449.00 Couple N/A $1,940.00 N/A $1,960.00 Individual N/A $4,319.00 N/A $4,359.00 Couple N/A $5,813.00 N/A $5,873.00 Individual N/A $2,127.00 N/A $2,147.00 Couple N/A $2,874.00 N/A $2,904.00 Working Disabled (WD) Individual N/A $5,383.00 N/A $5,433.00 Gross earnings limit Couple N/A $7,249.00 N/A $7,325.00 Working Disabled (WD) Individual N/A $2,659.00 N/A $2,684.00 Need Standard 250% FPL Couple N/A $3,592.00 N/A $3,630.00 Working Disabled (WD) Individual N/A $1,436.00 N/A $1,449.00 Unearned income limit 135% FPL Couple N/A $1,940.00 N/A $1,960.00 Qualifying Individuals (QI) 135% FPL Qualified Working Disabled Individuals Gross earnings limit Qualified Working Disabled Individuals (QWDI) 200% FPL LIBERALIZED RESOURCE LIMITS WORKING DISABLED RESOURCE LIMITS (liberalized) FEDERAL POVERTY LIMITS Qualified Medicare Beneficiaries (QMB) 100% FPL Healthier MS Waiver 135% FPL Specified Low-Income Medicare Beneficiaries (SLMB) 120% FPL RESOURCE LIMITS APPENDIX A-1-f CHART OF ABD AT-HOME NEED STANDARDS AND RESOURCE LIMITS EFFECTIVE DATE MEDICARE PREMIUMS SSI FEDERAL BENEFIT RATES