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Page 2 of 8 Appendix C-1 7/1/2023 Schedule V - Qualified Disabled and Working Individuals (QDWI) Monthly countable income and resources must be equal to or less than the following income and resource standards (200 percent of Federal Poverty Guidelines and double Supplemental Security Income (SSI) resource standards). Refer to OAC 317:35-7-41. Income standard Resource standard Individual $2,430 $4,000 Individual and spouse $3,287 $6,000 Schedule VI - Categorically Needy Standards for Qualified Medicare Beneficiary Plus (QMBP) Monthly countable income and resources must be equal to or less than the following income and resource standards (100 percent of Federal Poverty Guidelines and full benefit Medicare Part D low income subsidy resource standards). Refer to OAC 317:35-7-40. Income standard Resource standard Individual $1,215 $9,090 Individual and spouse $1,643 $13,630 Schedule VII - Specified Low Income Medicare Beneficiaries (SLMB) Monthly countable income and resources must be equal to or less than the following income and resource standards (120 percent of Federal Poverty Guidelines and full benefit Medicare Part D low income subsidy resource standards). Refer to OAC 317:35-7-43. Income standard Resource standard Individual $1,458 $9,090 Individual and spouse $1,972 $13,630 Schedule VII.A - Qualifying Individuals - Group One (QI-1s) Monthly countable income and resources must be equal to or less than the following income and resource standards (135 percent of Federal Poverty Guidelines and full benefit Medicare Part D low income subsidy resource standards). Refer to OAC 317:35-7-46. Income standard Resource standard Individual $1,640 $9,090 Individual and spouse $2,219 $13,630