Appendix XXXI, Budget Reference Chart

Revision 25-2; Effective June 1, 2025

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

Income — Effective Jan. 1, 2025, 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 — $967
  • Couple — $1,450
  • Deeming amount — $483

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, 2025:

  • One-third of the SSI FBR:
    • Individual — $322.33
    • Couple — $483.33
  • One-third of the SSI FBR + $20:
    • Individual — $342.33
    • Couple — $503.33
  • One-half of the couple 1/3 SSI FBR:
    • Companion — $241.67
  • One-half of the couple 1/3 SSI FBR + $10:
    • Companion — $251.67

All Living Arrangements

Effective Jan. 1, 2025, the special income exemption for a student’s earned income, regardless of living arrangement, is:

  • Monthly earnings — $2,350
  • Annual earnings — $9,460

Related Policy

Student Earnings, E-2220

Medicare Savings Programs (MSP)

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

Income — Effective March 1, 2025, total countable income must be:

  • QMB — Not more than 100% FPL:
    • Individual — $1,305
    • Couple — $1,763
    • Deeming amount — $458
    • Medicaid benefits are:
      • Part A premiums
      • Part B premiums
      • Deductibles
      • Coinsurance
  • SLMB — Greater than 100% FPL, but less than 120% FPL:
    • Individual — $1,305.01 to < $1,565
    • Couple — $1,763.01 to < $2,115
    • Deeming amount — $550
    • Medicaid benefits are:
      • Part B premiums
  • QI-1 — At least 120% FPL, but less than 135% FPL:
    • Individual — $1,565 to < $1,761
    • Couple — $2,115 to < $2,380
    • Deeming amount — $619
    • Medicaid benefits are:
      • Part B premiums
  • QDWI — No more than 200% FPL:
    • Individual — $2,609
    • Couple — $3,525
    • Deeming amount — $916
    • Medicaid benefits are:
      • Part A premiums

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

Resources — Effective Jan. 1, 2025, total countable resources must be:

  • QMB, SLMB, QI-1 — No more than the limit:
    • Individual — $9,660
    • Couple — $14,470
  • QDWI — No more than twice the SSI resource limit:
    • Individual — $4,000
    • Couple — $6,000

Medicaid Buy-In (MBI) Program

Income — Effective March 1, 2025:

  • Income eligibility is based on earnings.
  • Countable earned income must be less than the limit:
    • 250% of FPL — $3,261

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

MBI Monthly Premiums: Countable Unearned Income Minus (−) SSI FBR of $967 Plus (+) Earned Income Premium

Unearned Income Premium
Countable Unearned Income Minus (−) SSI FBR $967

Earned Income Premium

Countable Earned Income Based on FPL Range

FPLRangeEarned Income Premium
at or below 150% FPLLess than or equal to $1,957$0
150%–185% of FPLMore than $1,957 up to and including $2,413$20
>185%–200% of FPLMore than $2,413 up to and including $2,609$25
>200%–250% of FPLMore than $2,609 up to and including $3,261$30
>250% of FPLMore than $3,261$40

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, 2025:

  • 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 Size150% FPL
1$1,957
2$2,644
3$3,332
4$4,019
5$4,707
6$5,394
7$6,082
8$6,769

Ineligible sibling exclusion amount (150% FPL x 2 + $85) = $3,999

FPL Amounts for Premium Determination

Family Size150% FPL200% FPL300% FPL
1$1,957$2,609$3,913
2$2,644$3,525$5,288
3$3,332$4,442$6,663
4$4,019$5,359$8,038
5$4,707$6,275$9,413
6$5,394$7,192$10,788
7$6,082$8,109$12,163
8$6,769$9,025$13,538

MBIC Premiums — No Employer-Sponsored Insurance (ESI)

Family IncomeFamily of 1 or 2 Premium AmountFamily 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 IncomeFamily of 1 or 2 Premium AmountFamily 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, 2025

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.
  • $518 — 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.
  • $285 — 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):

  • $185 — 2025 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)

  • $110.40 – 2025 Standard Medicare Part B-ID monthly premium.

Related Policy

Medicare Part B Premium, H-1800

Community Attendant Services (CAS)

Income — Effective Jan. 1, 2025, total countable income must be no more than the special income limit:

  • Individual — $2,901
  • Couple — $5,802

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

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

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

Income — Effective Jan. 1, 2025, total countable income must be no more than the special income limit:

  • Individual — $2,901
  • Couple — $5,802

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

  • Individual — $2,000
  • Couple — $3,000
  • Substantial home equity — $730,000
  • 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) —
    • $75 for a nursing facility recipient
    • $75 plus the Protected Earned Income (PEI) amount for a recipient in an ICF or 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:

  • Personal Needs Allowance (PNA) —
    • $75 for a nursing facility recipient
    • $75 plus the Protected Earned Income (PEI) amount for a recipient in an ICF or 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 — $3,948
  • Spousal Impoverishment Dependent Allowance — $2,555 effective July 1, 2024
  • 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
    • $31,584, the minimum resource amount set by federal law; but
    • cannot exceed $157,920, the maximum resource amount set by federal law.

Income-first minimum monthly maintenance needs allowance (MMMNA) for SPRA expansion also known as Spousal Allowance — $3,948

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