Revision 21-3; Effective September 1, 2021
Community-Based Programs Using SSI Limits (DAC, Pickle, Widow(er)s)
Income — Effective Jan. 1, 2021, 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 — $794
- Couple — $1,191
- Deeming amount — $397
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)
The value of food, shelter or both that a person receives from someone else.
Effective Jan. 1, 2021:
- One-third of the SSI FBR:
- Individual — $264.66
- Couple — $397
- One-third of the SSI FBR + 20:
- Individual — $284.66
- Couple — $417
- One-half of the couple 1/3 SSI FBR:
- Companion — $198.50
- One-half of the couple 1/3 SSI FBR + 10:
- Companion — $208.50
All Living Arrangements
Effective Jan. 1, 2021, the special income exemption for a student’s earned income (regardless of living arrangement).
- Monthly earnings — $1,930
- Annual earnings — $7,770
Related Policy
Student Earnings, E-2220
Medicare Savings Programs (MSP)
Income limits are based on the federal poverty level (FPL).
Income — Effective March 1, 2021, total countable income must be:
- QMB — Not more than 100 percent FPL:
- Individual — $1,074
- Couple — $1,452
- Deeming amount — $378
- Medicaid benefits are:
- Part A premiums
- Part B premiums
- Deductibles
- Coinsurance
- SLMB — Greater than 100 percent FPL, but less than 120 percent FPL:
- Individual — $1,074.01 to < $1,288
- Couple — $1,452.01 to < $1,742
- Deeming amount — $454
- Medicaid benefits are:
- Part B premiums
- QI-1 — At least 120 percent FPL, but less than 135 percent FPL:
- Individual — $1,288 to < $1,449
- Couple — $1,742 to < $1,960
- Deeming amount — $511
- Medicaid benefits are:
- Part B premiums
- QDWI — No more than 200 percent FPL:
- Individual — $2,147
- Couple — $2,904
- Deeming amount — $757
- Medicaid benefits are:
- Part A premiums
Note: These income limits do not include the $20 disregard for MSP.
Resources — Effective Jan. 1, 2021, total countable resources must be:
- QMB, SLMB, QI-1 — No more than the limit:
- Individual — $7,970
- Couple — $11,960
- QDWI — No more than twice the SSI resource limit:
- Individual — $4,000
- Couple — $6,000
Medicaid Buy-In (MBI) Program
Income — Effective March 1, 2021:
- Income eligibility is based on earnings.
- Countable earned income must be less than the limit:
- 250 percent of FPL — $2,684
Resources — Total countable resources must be no more than the limit of $2,000.
MBI Monthly Premiums: Countable Unearned Income Minus (−) SSI FBR of $794 Plus (+) Earned Income Premium
Unearned Income Premium
Countable Unearned Income Minus (−) SSI FBR of $794
Earned Income Premium
| Countable Earned Income Based on FPL Range | ||
|---|---|---|
| FPL | Dollar Range | Earned Income Premium |
|
|
Less than or equal to $1,610 |
$0 |
|
150%–185% of FPL |
Greater than $1,610 up to and including $1,986 |
$20 |
|
>185%–200% of FPL |
Greater than $1,986 up to and including $2,147 |
$25 |
|
>200%–250% of FPL |
Greater than $2,147 up to and including $2,684 |
$30 |
|
>250% of FPL |
Greater than $2,684 |
$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, 2021:
- MBIC income exclusion — $85 plus one-half of the remaining income.
- Eligibility — No more than 150 percent FPL based on family size.
These amounts do not include the MBIC income exclusion.
| FPL Amounts for Income Eligibility | |
|---|---|
| Family Size | 150% FPL |
| 1 | $1,610 |
| 2 | $2,178 |
| 3 | $2,745 |
| 4 | $3,313 |
| 5 | $3,880 |
| 6 | $4,448 |
| 7 | $5,015 |
| 8 | $5,583 |
Ineligible sibling exclusion amount (150% FPL x 2 + $85) — $3,305
| Family Size | 150% FPL | 200% FPL | 300% FPL |
|---|---|---|---|
| 1 | $1,610 | $2,147 | $3,220 |
| 2 | $2,178 | $2,904 | $4,355 |
| 3 | $2,745 | $3,660 | $5,490 |
| 4 | $3,313 | $4,417 | $6,625 |
| 5 | $3,880 | $5,174 | $7,760 |
| 6 | $4,448 | $5,930 | $8,895 |
| 7 | $5,015 | $6,687 | $10,030 |
| 8 | $5,583 | $7,444 | $11,165 |
| 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, 2021
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.
- $471 — 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.
- $259 — 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):
- $148.50 — 2021 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, 2021, total countable income must be no more than the special income limit:
- Individual — $2,382
- Couple — $4,764
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, 2021, total countable income must be no more than the special income limit:
- Individual — $2,382
- Couple — $4,764
Resources —Total countable resources must be no more than the limit:
- Individual — $2,000
- Couple — $3,000
- Substantial home equity — $603,000.00
- Transfer of assets (TOA) divisor — $237.93 daily rate (effective Sept. 1, 2021)
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)
- $2,382 (HCBS waiver recipient)
- Guardianship Fees — Varies
- Dependent Allowance — $794
- Incurred Medical Expenses — Varies
- Deduction for Home Maintenance — Up to $794
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)
- $2,382 (HCBS waiver recipient)
- Guardianship Fees — Varies
- Minimum Monthly Maintenance Needs Allowance (MMMNA) (Spousal allowance) — $3,259.50
- Spousal Impoverishment Dependent Allowance — $2,178 (effective July 1, 2021)
- 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 — $26,076.00); but
- SPRA is not to exceed the maximum resource amount set by federal law (SPRA maximum — $130,380.00).
Income-first minimum monthly maintenance needs allowance (MMMNA) for SPRA expansion (Spousal Allowance) — $3,259.50
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