Appendix XXXI, Budget Reference Chart | Texas Health and Human Services

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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

FPL	Range	Earned Income Premium
at or below 150% FPL	Less than or equal to $1,957	$0
150%–185% of FPL	More than $1,957 up to and including $2,413	$20
>185%–200% of FPL	More than $2,413 up to and including $2,609	$25
>200%–250% of FPL	More than $2,609 up to and including $3,261	$30
>250% of FPL	More 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 Size	150% 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 Size	150% FPL	200% FPL	300% 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 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, 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