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
Countable Earned Income Based on FPL Range | ||
---|---|---|
FPL | Dollar Range | Earned Income Premium |
at or below 150% FPL | Less than or equal to $1,823 | $0 |
150%–185% of FPL | Greater than $1,823 up to and including $2,248 | $20 |
>185%–200% of FPL | Greater than $2,248 up to and including $2,430 | $25 |
>200%–250% of FPL | Greater than $2,430 up to and including $3,038 | $30 |
>250% of FPL | Greater than $3,038 | $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, 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.
FPL Amounts for Income Eligibility | |
---|---|
Family Size | 150% FPL |
1 | $1,823 |
2 | $2,465 |
3 | $3,108 |
4 | $3,750 |
5 | $4,393 |
6 | $5,035 |
7 | $5,678 |
8 | $6,320 |
Ineligible sibling exclusion amount (150% FPL x 2 + $85) — $3,731
Family Size | 150% FPL | 200% FPL | 300% FPL |
---|---|---|---|
1 | $1,823 | $2,430 | $3,645 |
2 | $2,465 | $3,287 | $4,930 |
3 | $3,108 | $4,144 | $6,215 |
4 | $3,750 | $5,000 | $7,500 |
5 | $4,393 | $5,857 | $8,785 |
6 | $5,035 | $6,714 | $10,070 |
7 | $5,678 | $7,570 | $11,355 |
8 | $6,320 | $8,427 | $12,640 |
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 |
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, 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