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West Virginia Income Maintenance Manual Chapter 26

West Virginia Income Maintenance Manual Page 34 Chapter 26 Medicaid Work Incentive (M-WIN)

APPENDIX A: M-WIN PROGRAM PREMIUM AMOUNTS

Monthly Gross Income Premium Amount $500 or Less $15.00 $501 – 700 $17.50 $701 – 900 $24.50 $901 – 1100 $31.50 $1101 – 1300 $38.50 $1301 – 1500 $45.50 $1501 – 1700 $52.50 $1701 – 1900 $59.50 $1901 – 2100 $66.50 $2101 – 2300 $73.50 $2301 – 2500 $80.50 $2501 – 2700 $87.50 $2701 – 2900 $94.50 $2901 – 3100 $101.50 $3101 – 3300 $108.50 $3301 – 3500 $115.50 $3501 – 3700 $122.50 $3701 – 3826* $129.50 *Individuals whose monthly gross income exceeds $3,826 pay the maximum premium amount of $129.50.

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Page 2158

Official source

West Virginia Income Maintenance Manual Chapter 26

West Virginia Income Maintenance Manual Page 34 Chapter 26 Medicaid Work Incentive (M-WIN)

APPENDIX A: M-WIN PROGRAM PREMIUM AMOUNTS

Monthly Gross Income Premium Amount $500 or Less $15.00 $501 – 700 $17.50 $701 – 900 $24.50 $901 – 1100 $31.50 $1101 – 1300 $38.50 $1301 – 1500 $45.50 $1501 – 1700 $52.50 $1701 – 1900 $59.50 $1901 – 2100 $66.50 $2101 – 2300 $73.50 $2301 – 2500 $80.50 $2501 – 2700 $87.50 $2701 – 2900 $94.50 $2901 – 3100 $101.50 $3101 – 3300 $108.50 $3301 – 3500 $115.50 $3501 – 3700 $122.50 $3701 – 3826* $129.50 *Individuals whose monthly gross income exceeds $3,826 pay the maximum premium amount of $129.50.