Page 9

MEDICAID ELIGIBILITY MANUAL Revised 07/01/2017 1/1/2010 3/1/2010 1/1/2011 3/1/2011 Part A $461.00 NA $450.00 NA Part B $110.50 NA $115.40 NA SSI Individual FBR Own Household (LA-A) $674.00 NA $674.00 NA Title XIX Facility (LA-D) $30.00 NA $30.00 NA SSI Couple FBR Own Household (LA-A) $1,011.00 NA $1,011.00 NA Deeming Allocation-Ineligible Child $337.00 NA $337.00 NA Presumed Maximum Value (PMV) Individual $244.67 NA $244.67 NA Couple $357.00 NA $357.00 NA 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 N/A $903.00 NA $908.00 Couple N/A $1,215.00 NA $1,226.00 Individual N/A $1,219.00 NA $1,226.00 Couple N/A $1,640.00 NA $1,655.00 Individual N/A $1,083.00 NA $1,089.00 Couple N/A $1,457.00 NA $1,471.00 Individual N/A $1,219.00 NA $1,226.00 Couple N/A $1,640.00 NA $1,655.00 Individual N/A $1,805.00 NA $1,815.00 Couple N/A $2,429.00 NA $2,452.00 Working Disabled (WD) Individual N/A $4,579.00 NA $4,603.00 Gross earnings limit Couple N/A $6,137.00 NA $6,195.00 Working Disabled (WD) Individual N/A $2,257.00 NA $2,269.00 Need Standard 250% FPL Couple N/A $3,036.00 NA $3,065.00 Working Disabled (WD) Individual N/A $1,219.00 NA $1,226.00 Unearned income limit 135% FPL Couple N/A $1,640.00 NA $1,655.00 SSI RESOURCE LIMITS SSI FEDERAL BENEFIT RATES FEDERAL POVERTY LIMITS APPENDIX A-1-a Qualified Working Disabled Individuals (QWDI) 200% FPL LIBERALIZED RESOURCE LIMITS CHART OF ABD AT-HOME NEED STANDARDS AND RESOURCE LIMITS Qualified Medicare Beneficiaries (QMB) 100% FPL Healthier MS Waiver 135% FPL Specified Low-Income Medicare Beneficiaries (SLMB) 120% FPL Qualifying Individuals (QI) 135% FPL WORKING DISABLED RESOURCE LIMITS (liberalized) EFFECTIVE DATE MEDICARE PREMIUMS