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MEDICAID ELIGIBILITY MANUAL Revised 07/01/2017 1/1/2014 3/1/2014 1/1/2015 3/1/2015 Part A $426.00 NA $407.00 N/A Part B $104.90 NA $104.90 N/A SSI Individual FBR Own Household (LA-A) $721.00 NA $733.00 N/A Title XIX Facility (LA-D) $30.00 NA $30.00 N/A SSI Couple FBR Own Household (LA-A) $1,082 NA $1,100.00 N/A Deeming Allocation-Ineligible Child $360.50 NA $366.50 N/A Presumed Maximum Value (PMV) Individual $260.33 NA $264.33 N/A Couple 380.67 NA $386.66 N/A SSI RESOURCE LIMITS Individual $2,000.00 $2,000.00 $2,000.00 $2,000.00 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 NA $973.00 N/A $981.00 Couple NA $1,311.00 N/A $1,328.00 Individual NA $1,313.00 N/A $1,325.00 Couple NA $1,770.00 N/A $1,793.00 Individual NA $1,167.00 N/A $1,177.00 Couple NA $1,573.00 N/A $1,593.00 Individual NA $1,313.00 N/A $1,325.00 Couple NA $1,770.00 N/A $1,793.00 Individual NA $1,945.00 N/A $1,962.00 Couple NA $2,622.00 N/A $2,655.00 Working Disabled (WD) Individual NA $4,929.00 N/A $4,971.00 Gross earnings limit Couple NA $6,621.00 N/A $6,703.00 Working Disabled (WD) Individual NA $2,432.00 N/A $2,453.00 Need Standard 250% FPL Couple NA $3,278.00 N/A $3,319.00 Working Disabled (WD) Individual NA $1,313.00 N/A $1,325.00 Unearned income limit 135% FPL Couple NA $1,770.00 N/A $1,793.00 Qualifying Individuals (QI) 135% FPL Qualified Working Disabled Individuals (QWDI) 200% FPL Specified Low-Income Medicare Beneficiaries (SLMB) 120% FPL APPENDIX A- 1-c 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 RESOURCE LIMITS FEDERAL POVERTY LIMITS