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MEDICAID ELIGIBILITY MANUAL Revised 07/01/2017 1/1/2016 3/1/2016 1/1/2017 3/1/2017 Part A $411.00 N/A $413.00 N/A Part B $104.90 $121.80 N/A 109.00 134.00 N/A SSI Individual FBR Own Household (LA-A) $733.00 N/A $735.00 N/A Title XIX Facility (LA-D) $30.00 N/A $30.00 N/A SSI Couple FBR Own Household (LA-A) $1,100.00 N/A $1,103.00 N/A Deeming Allocation-Ineligible Child $367.00 N/A $368.00 N/A Presumed Maximum Value (PMV) Individual $264.33 N/A $265.00 N/A Couple $386.66 N/A $387.66 N/A SSI RESOURCE LIMITS Individual $2,000.00 $2,000.00 $2,000.00 $2,000.00 SSI RESOURCE LIMITS Couple $3,000.00 $3,000.00 $3,000.00 $3,000.00 Individual $4.000.00 $4.000.00 $4.000.00 $4,000.00 Couple $6,000.00 $6,000.00 $6,000.00 $6,000.00 Individual $24,000.00 $24,000.00 $24,000.00 $24,000.00 Couple $26,000.00 $26,000.00 $26,000.00 $26,000.00 Individual N/A $990.00 N/A $1,005.00 Couple N/A $1,335.00 N/A $1,354.00 Individual N/A $1,337.00 N/A $1,357.00 Couple N/A $1,803.00 N/A $1,827.00 Individual N/A $1,188.00 N/A $1,206.00 Couple N/A $1,602.00 N/A $1,624.00 Individual N/A $1,337.00 N/A $1,357.00 Couple N/A $1,803.00 N/A $1,827.00 Individual N/A $1,980.00 N/A $2,010.00 Couple N/A $2,670.00 N/A $2,707.00 Working Disabled (WD) Individual N/A $5,015.00 N/A $5,091.00 Gross earnings limit Couple N/A $6,741.00 N/A $6,833.00 Working Disabled (WD) Individual N/A $2,475.00 N/A $2,513.00 Need Standard 250% FPL Couple N/A $3,338.00 N/A $3,384.00 Working Disabled (WD) Individual N/A $1,337.00 N/A $1,357.00 Unearned income limit 135% FPL Couple N/A $1,803.00 N/A $1,827.00 Qualifying Individuals (QI) 135% FPL Qualified Working Disabled Individuals (QWDI) 200% FPL Specified Low-Income Medicare Beneficiaries (SLMB) 120% FPL APPENDIX A- 1- d CHART OF ABD AT-HOME NEED STANDARDS AND RESOURCE LIMITS LIBERALIZED RESOURCE LIMITS Qualified Medicare Beneficiaries (QMB) 100% FPL Healthier MS Waiver 135% FPL WORKING DISABLED RESOURCE LIMITS (liberalized) EFFECTIVE DATE MEDICARE PREMIUMS SSI FEDERAL BENEFIT RATES FEDERAL POVERTY LIMITS