Appendix XXXI, Budget Reference Chart

Revision 23-3; Effective Sept. 1, 2023

Community-Based Programs Using SSI Limits (DAC, Pickle, Widow(er)s)

Income — Effective Jan. 1, 2023, 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 — $914
• Couple — $1,371
• Deeming amount — $457

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, 2023:

• One-third of the SSI FBR:
  • Individual — $304.66
  • Couple — $457.00
• One-third of the SSI FBR + $20:
  • Individual — $324.66
  • Couple — $477.00
• One-half of the couple 1/3 SSI FBR:
  • Companion — $228.50
• One-half of the couple 1/3 SSI FBR + $10:
  • Companion — $238.50

All Living Arrangements

Effective Jan. 1, 2023, the special income exemption for a student’s earned income, regardless of living arrangement, is:

• Monthly earnings — $2,220
• Annual earnings — $8,950

Related Policy

Student Earnings, E-2220

Medicare Savings Programs (MSP)

Income limits are based on the federal poverty level (FPL).

Income — Effective March 1, 2023, total countable income must be:

• QMB — Not more than 100% FPL:
  • Individual — $1,215
  • Couple — $1,643
  • Deeming amount — $428
  • Medicaid benefits are:
    • Part A premiums
    • Part B premiums
    • Deductibles
    • Coinsurance
• SLMB — Greater than 100% FPL, but less than 120% FPL:
  • Individual — $1,215.01 to < $1,458
  • Couple — $1,643.01 to < $1,972
  • Deeming amount — $514
  • Medicaid benefits are:
    • Part B premiums
• QI-1 — At least 120% FPL, but less than 135% FPL:
  • Individual — $1,458 to < $1,640
  • Couple — $1,972 to < $2,219
  • Deeming amount — $579
  • Medicaid benefits are:
    • Part B premiums
• QDWI — No more than 200% FPL:
  • Individual — $2,430
  • Couple — $3,287
  • Deeming amount — $857
  • Medicaid benefits are:
    • Part A premiums

Note: These income limits do not include the $20 disregard for MSP.

Resources — Effective Jan. 1, 2023, total countable resources must be:

• QMB, SLMB, QI-1 — No more than the limit:
  • Individual — $9,090
  • Couple — $13,630
• QDWI — No more than twice the SSI resource limit:
  • Individual — $4,000
  • Couple — $6,000

Medicaid Buy-In (MBI) Program

Income — Effective March 1, 2023:

• Income eligibility is based on earnings.
• Countable earned income must be less than the limit:
  • 250% of FPL — $3,038

Resources — Total countable resources must be no more than the limit of $2,000.

MBI Monthly Premiums: Countable Unearned Income Minus (−) SSI FBR of $914 Plus (+) Earned Income Premium

Unearned Income Premium
Countable Unearned Income Minus (−) SSI FBR $914

Earned Income Premium

If the unearned income premium amount plus the earned income premium amount equals or exceeds $500, then the total monthly premium remains at $500.

Medicaid Buy-In for Children (MBIC) Program

Resources — No resource test for MBIC.

Income — Effective March 1, 2023:

• 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.

Ineligible sibling exclusion amount (150% FPL x 2 + $85) — $3,731

MBIC Premiums — ESI and No State-Paid HIPP

No MBIC premium.

Medicare Premiums

Effective Jan. 1, 2023

Part A Premium (Hospital Insurance):

• $0 — Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
• $506 — 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.
• $278 — 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):

• $164.90 — 2023 standard Medicare Part B monthly premium.

Staff must use the Medicare Part B amount as verified in the State Online Query (SOLQ).

Related Policy

Medicare Part B Premium, H-1800

Community Attendant Services (CAS)

Income — Effective Jan. 1, 2023, total countable income must be no more than the special income limit:

• Individual — $2,742
• Couple — $5,484

Resources — Total countable resources must be no more than the limit:

• Individual — $2,000
• Couple — $3,000

Institutional Living Arrangement (Individuals residing 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 an individual is equal to or less than 300% of the SSI federal benefit rate.

Income — Effective Jan. 1, 2023, total countable income must be no more than the special income limit:

• Individual — $2,742
• Couple — $5,484

Resources —Total countable resources must be no more than the limit:

• Individual — $2,000
• Couple — $3,000
• Substantial home equity — $688,000.00
• Transfer of assets (TOA) divisor — $242.13 daily rate (effective Sept. 1, 2023)

Note: The Transfer of Assets daily rate is reviewed every other year.

Co-Payment

Individual or Couple Co-Payment Budget:

• Personal Needs Allowance (PNA) —
  • $60 (nursing facility recipient)
  • $60 plus the Protected Earned Income (PEI) amount (recipient in an ICF/IID facility)
  • $85 (recipient in foster care or assisted living)
  • $2,742 (HCBS waiver recipient)
• Guardianship Fees — Varies
• Dependent Allowance — $914
• Incurred Medical Expenses — Varies
• Deduction for Home Maintenance — Up to $914

Spousal Co-payment Budget:

• Personal Needs Allowance (PNA) —
  • $60 (nursing facility recipient)
  • $60 plus the Protected Earned Income (PEI) amount (recipient in an ICF/IID facility)
  • $85 (recipient in foster care or assisted living)
  • $2,742 (HCBS waiver recipient)
• Guardianship Fees — Varies
• Minimum Monthly Maintenance Needs Allowance (MMMNA) (Spousal allowance) — $3,715.50
• Spousal Impoverishment Dependent Allowance — $2,465 (effective July 1, 2023)
• 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
  • the minimum resource amount set by federal law (SPRA minimum — $29,724); but
  • SPRA is not to exceed the maximum resource amount set by federal law (SPRA maximum — $148,620).

Income-first minimum monthly maintenance needs allowance (MMMNA) for SPRA expansion (Spousal Allowance) — $3,715.50

Related Policy

Personal Needs Allowance (PNA), H-1500
Guardianship Fees, H-1550
Dependent Allowance, H-1600
Deduction for Home Maintenance, H-1700
Incurred Medical Expenses, H-2000
Spousal Impoverishment Dependent Allowance, J-7400