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MEDICAID ELIGIBILITY MANUAL Revised 07/01/2017 1/1/2012 3/1/2012 1/1/2013 3/1/2013 Part A $451.00 NA $441.00 NA Part B $99.90 NA $104.90 NA SSI Individual FBR Own Household (LA-A) $698.00 NA $710.00 NA Title XIX Facility (LA-D) $30.00 NA $30.00 NA SSI Couple FBR Own Household (LA-A) $1,048.00 NA $1,066.00 NA Deeming Allocation-Ineligible Child $349.00 NA $355.00 NA Presumed Maximum Value (PMV) Individual $252.67 NA $256.67 NA Couple $369.33 NA $375.33 NA 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 $931.00 NA $958.00 Couple NA $1,261.00 NA $1,293.00 Individual NA $1,257.00 NA $1,293.00 Couple NA $1,703.00 NA $1,745.00 Individual NA $1,117.00 NA $1,149.00 Couple NA $1,513.00 NA $1,551.00 Individual NA $1,257.00 NA $1,293.00 Couple NA $1,703.00 NA $1,745.00 Individual NA $1,862.00 NA $1,915.00 Couple NA $2,522.00 NA $2,585.00 Working Disabled (WD) Individual NA $4,721.00 NA $4,853.00 Gross earnings limit Couple NA $6,371.00 NA $6,529.00 Working Disabled (WD) Individual NA $2,328.00 NA $2,394.00 Need Standard 250% FPL Couple NA $3,153.00 NA $3,232.00 Working Disabled (WD) Individual NA $1,257.00 NA $1,293.00 Unearned income limit 135% FPL Couple NA $1,703.00 NA $1,745.00 Qualifying Individuals (QI) 135% FPL Qualified Working Disabled Individuals (QWDI) 200% FPL Specified Low-Income Medicare Beneficiaries (SLMB) 120% FPL APPENDIX A- 1-b 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