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1 2 1 2 Under Age 21, ADC-RELATED Medicaid Income Level 1,836 2,489 SSI-Related Medicaid Income Level 1,836 2,489 33,038 44,796 Household size is always one or two. COBRA Continuation Coverage 100% FPL 1,330 1,804 4,000 6,000 A/R may be eligible for Medicaid to pay the COBRA premium. AIDS Insurance 185% FPL 2,461 3,337 A/R must be ineligible for Medicaid, including COBRA continuation. Qualified Medicare Beneficiary (QMB) 138% FPL 1,836 2,489 If the A/R is determined eligible, Medicaid will pay Part B and/or A premium, coinsurance and deductible. 1,836 2,489 2,474 3,355 Qualified Disabled & Working Individual (QDWI) 200% FPL 2,660 3,607 4,000 6,000 If the A/R is determined eligible, Medicaid will pay Medicare Part A premium. Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD) 250% FPL 3,325 4,509 33,038 44,796 Countable retirement accounts are disregarded as resources effective 10/01/11. Rev. 02.05.2026 If the A/R is determined eligible, Medicaid will pay Medicare Part B premium. The A/R must have part A to qualify. No Resource Test No Resource Test No Resource Test Qualifying Individual (QI) Greater than (>)138% but less than or equal to (≤)186% FPL No Resource Test Non-MAGI Population Category Income Compared to: Household Size Resource Level Special Notes