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Division of Welfare and Supportive Services APPENDIX C Medical Assistance Manual MAABD Sept 24 MTL 08/24 INCOME STANDARD CHART 2024 MAABD INCOME STANDARD CHART SSI BUDGETING Child Allocation Amount $472.00 Parent Allocation Amount - One Parent $943.00 - Two Parents $1,415.00 Deeming Indicator Amount $472.00

HIWA BUDGETING Gross Unearned Income $699.00 Gross Earned Income (effective. 04/24) $5,648.00 Combined Net Income (effective. 04/24) $3,138.00

PATIENT LIABILITY Home and Community Based Waivers Personal Needs Allowance - DMH – MR Waiver Allowance $2,829.00 - Aged – Independent Living $2,829.00 - Aged – Group Care $2,829.00 - Disabled Waiver $2,829.00 HBW Spouse Allowance $707.50 Institutional Spouse Allowance $943.00 - Dependent Need Standard (effective. 04/24) $942.00 - Each Additional Child (effective. 04/24) $336.00

SPOUSAL IMPOVERISHMENT State Medicaid Maximum Resource Share $30,828.00 Federal Maximum Spousal Resource Share $154,140.00 Federal Maximum Maintenance Need Standard $3,853.50 Federal Minimum Maintenance Need Standard (effective. 04/24) $2,555.00 Federal Excess Shelter Deduction (effective. 04/24) $766.50

HOME EQUITY Individual Limit $713,000.00 Couple Limit $1,071,000.00

LONG TERM CARE/HOME BASED WAIVER CASES Gross Income Limit $2,829.00 Average Cost Private Nursing Care (effective. 04/24) $9,949.26

MEDICARE BENEFICIARY INCOME LIMITS (Effective 04/24) INDIVIDUAL COUPLE QMB $0 .00 - $1,255.00 $0 .00 - $1,704.00 SLMB $1,255.01 - $1,506.00 $1,704.01 - $2,044.00 QI1 $1,506.01 - $1,695.00 $2,044.01 - $2,300.00 QDWI $1,695.01 - $2,510.00 $2,300.01 - $3,407.00

MEDICARE MONTHLY PREMIUMS Part A Hospital $505.00 Part B Medical $174.70