loading…
loading…
loading…
Income — Effective Jan. 1, 2026, total countable income must be less than the Supplemental Security Income (SSI) federal benefit rate (FBR) with the exclusion of certain increases in Social Security benefits:
Individual — $994
Couple — $1,491
Deeming amount — $497
Resources — Total countable resources must be no more than the limit:
Individual — $2,000
Couple — $3,000
Companion — $3,000
In-Kind Support and Maintenance (Community Living Arrangement)
Effective Jan. 1, 2026:
One-third of the SSI FBR: Individual — $331.33 Couple — $497.00
One-third of the SSI FBR + $20: Individual — $351.33 Couple — $517.00
One-half of the couple 1/3 SSI FBR: Companion — $248.50
One-half of the couple 1/3 SSI FBR + $10: Companion — $258.50
All Living Arrangements
Effective Jan. 1, 2026, the special income exemption for a student’s earned income, regardless of living arrangement, is:
Monthly earnings — $2,410
Annual earnings — $9,730
Related Policy
Student Earnings, E-2220
Medicare Savings Programs (MSP)
Income limits are based on the federal poverty level (FPL) .
Income — Effective March 1, 2026, total countable income must be:
QMB — Not more than 100% FPL: Individual — $1,330 Couple — $1,804 Deeming amount — $474 Medicaid benefits are: Part A premiums Part B premiums Deductibles Coinsurance
SLMB — Greater than 100% FPL, but less than 120% FPL: Individual — $1,330.01 to < $1,596 Couple — $1,804.01 to < $2,164 Deeming amount — $568 Medicaid benefits are: Part B premiums
QI-1 — At least 120% FPL, but less than 135% FPL: Individual — $1,596 to < $1,796 Couple — $2,164 to < $2,435 Deeming amount — $639 Medicaid benefits are: Part B premiums
QDWI — No more than 200% FPL: Individual — $ 2,660 Couple — $3,607 Deeming amount — $947 Medicaid benefits are: Part A premiums
Note: These income limits do not include the $20 disregard for MSP.
Resources — Effective Jan. 1, 2026, total countable resources must be:
QMB, SLMB, QI-1 — No more than the limit: Individual — $9,950 Couple — $14,910
QDWI — No more than twice the SSI resource limit: Individual — $4,000 Couple — $6,000
Medicaid Buy-In (MBI) Program
Income — Effective March 1, 2026:
Income eligibility is based on earnings.
Countable earned income must be less than the limit: 250% of FPL — $3,325
Resources — Total countable resources must be no more than the limit of $2,000.
MBI Monthly Premiums: Countable Unearned Income Minus (−) SSI FBR of $994 Plus (+) Earned Income Premium
Unearned Income Premium Countable Unearned Income Minus (−) SSI FBR $994
Earned Income Premium
Countable Earned Income Based on FPL Range
FPL Range Earned Income Premium at or below 150% FPL Less than or equal to $1,995 $0 150%–185% of FPL More than $41,995 up to and including $2,461 $20 >185%–200% of FPL More than $2,461 up to and including $2,660 $25 >200%–250% of FPL More than $2,660 up to and including $3,325 $30 >250% of FPL More than $3,325 $40
If the unearned income premium amount plus the earned income premium amount equals or exceeds $500, then the total monthly premium stays at $500.
Medicaid Buy-In for Children (MBIC) Program
Resources — No resource test for MBIC.
Income — Effective March 1, 2026:
MBIC income exclusion — $85 plus one-half of the remaining income.
Eligibility — No more than 150% FPL based on family size.
These amounts do not include the MBIC income exclusion.
FPL Amounts for Income Eligibility
Family Size 150% FPL 1 $1,995 2 $2,705 3 $3,415 4 $4,125 5 $4,835 6 $5,545 7 $6,255 8 $6,965
Ineligible sibling exclusion amount (150% FPL x 2 + $85) = $4,075
FPL Amounts for Premium Determination
Family Size 150% FPL 200% FPL 300% FPL 1 $1,995 $2,660 $3,990 2 $2,705 $3,607 $5,410 3 $3,415 $4,554 $6,830 4 $4,125 $5,500 $8,250 5 $4,835 $6,447 $9,670 6 $5,545 $7,394 $11,090 7 $6,255 $8,340 $12,510 8 $6,965 $9,287 $13,930
MBIC Premiums — No Employer-Sponsored Insurance (ESI)
Family Income Family of 1 or 2 Premium Amount Family of 3 or More Premium Amount At or below 150% FPL $0 $0 151–200% FPL $90 $115 201–300% FPL $180 $230
MBIC Premiums — ESI with State-Paid Health Insurance Premium Program (HIPP)
Family Income Family of 1 or 2 Premium Amount Family of 3 or More Premium Amount At or below 150% FPL $0 $0 151–200% FPL $25 $35 201–300% FPL $50 $70
MBIC Premiums — ESI and No State-Paid HIPP
No MBIC premium.
Medicare Premiums
Effective Jan. 1, 2026
Part A Premium (Hospital Insurance):
$0 — Most people do not pay a monthly Part A premium because they or a spouse have 40 or more quarters of Medicare-covered employment.
$565 — Standard Medicare Part A monthly premium cost — The monthly Part A premium for people who are not otherwise eligible for premium-free hospital insurance and who have less than 30 quarters of Medicare-covered employment.
$311 — Reduced Medicare Part A premium — The monthly Part A premium for people who have 30–39 quarters of Medicare-covered employment.
Part B Premium (Medical Insurance):
$202.90 — 2026 standard Medicare Part B monthly premium.
Staff must use the Medicare Part B amount as verified in the State Online Query (SOLQ).
Part B-ID Premium (Immunosuppressive Drugs only)
$121.60 – 2026 Standard Medicare Part B-ID monthly premium.
Related Policy
Medicare Part B Premium, H-1800
Community Attendant Services (CAS)
Income — Effective Jan. 1, 2026, total countable income must be no more than the special income limit:
Individual — $2,982
Couple — $5,964
Resources — Total countable resources must be no more than the limit:
Individual — $2,000
Couple — $3,000
Institutional Living Arrangement
When people are living in a Medicaid certified long-term care facility or receiving Home and Community Based Waiver services.
Individual or Couple Eligibility Budget
Special income limit — The special income limit for a person is equal to or less than 300% of the SSI federal benefit rate.
Income — Effective Jan. 1, 2026, total countable income must be no more than the special income limit:
Individual — $2,982
Couple — $5,964
Resources —Total countable resources must be no more than the limit:
Individual — $2,000
Couple — $3,000
Substantial home equity — $752,000
Transfer of assets (TOA) divisor — $262.37 daily rate effective Sept. 1, 2025.
Note: The transfer of assets daily rate is reviewed every other year.
Co-Payment
Individual or Couple Co-Payment Budget:
Personal Needs Allowance (PNA) $75 for a nursing facility recipient $75 plus the Protected Earned Income (PEI) amount for a recipient in an ICF/IID facility $85 for a recipient in foster care or assisted living $2,901 for an HCBS waiver recipient
Guardianship Fees — Varies
Dependent Allowance — $967
Incurred Medical Expenses — Varies
Deduction for Home Maintenance — Up to $967
Spousal Co-payment Budget:
PNA $75 for a nursing facility recipient $75 plus the PEI amount for a recipient in an ICF/IID facility $85 for a recipient in foster care or assisted living $2,901 for an HCBS waiver recipient
Guardianship Fees — Varies
Minimum Monthly Maintenance Needs Allowance (MMMNA) also known as Spousal Allowance — $4,066.50
Spousal Impoverishment Dependent Allowance — $2,643.75 effective July 1, 2025
Incurred Medical Expenses — Varies
Calculation of the Spousal Protected Resource Amount (SPRA):
SPRA is the greater of: one-half of the couple's combined countable resources; or $32,532, the minimum resource amount set by federal law; but cannot exceed $162,660, the maximum resource amount set by federal law.
Income-first MMMNA for SPRA expansion also known as Spousal Allowance — $4,066.50