C-130, Medical Programs

C—131 Income Limits

Revision 13-3; Effective July 1, 2013

 

C—131.1 Federal Poverty Level (FPL)

Revision 22-2; Effective April 1, 2022

TP 33, TP 34, TP 35, TP 36, TP 43, TP 44, TP 48, TP 40, TP 42, TA 74, TA 75 and TA 76

Family Size 133% FPL
(3-1-22)
TP 44, 34, TA 76
144% FPL
(3-1-22)
TP 48, 33, TA 75
198% FPL
(3-1-22)
TP 40, 42, 43, 36, 35, TA 74
1 $1,510 $1,631 $2,243
2 $2,034 $2,198 $3,022
3 $2,559 $2,764 $3,800
4 $3,083 $3,330 $4,579
5 $3,607 $3,897 $5,358
6 $4,132 $4,463 $6,137
7 $4,656 $5,030 $6,916
8 $5,180 $5,596 $7,694
9 $5,705 $6,162 $8,473
10 $6,229 $6,729 $9,252
11 $6,753 $7,295 $10,031
12 $7,278 $7,862 $10,810
13 $7,802 $8,428 $11,588
14 $8,326 $8,994 $12,367
15 $8,851 $9,561 $13,146
For each additional person $525 $567 $779

Note: See C-1114, Guidelines for Providing Retroactive Coverage for Children and Medical Programs, for the income limits.

TA 41, TA 84 (CHIP), TA 85 (CHIP-P), TA 77 and TP 70

Family Size 201% FPL
(3-1-22)
TA 84
202% FPL
(3-1-22)
TA 85
204.2% FPL
(3-20-22)
TA 41
400% FPL
(3-1-22)
TA 77
413% FPL
(3-1-22)
TP 70
1 $2,277 $2,288 $2,313 $4,530 $4,678
2 $3,067 $3,083 $3,116 $6,104 $6,302
3 $3,858 $3,877 $3,919 $7,677 $7,927
4 $4,649 $4,672 $4,723 $9,250 $9,551
5 $5,439 $5,466 $5,526 $10,824 $11,176
6 $6,230 $6,261 $6,329 $12,397 $12,800
7 $7,020 $7,055 $7,132 $13,970 $14,425
8 $7,811 $7,850 $7,935 $15,544 $16,049
9 $8,602 $8,644 $8,739 $17,117 $17,673
10 $9,392 $9,439 $9,542 $18,690 $19,298
11 $10,183 $10,233 $10,345 $20,264 $20,922
12 $10,973 $11,028 $11,148 $21,837 $22,547
13 $11,764 $11,823 $11,951 $23,410 $24,171
14 $12,555 $12,617 $12,754 $24,984 $25,796
15 $13,345 $13,412 $13,558 $26,557 $27,420
For each additional person $791 $795 $804 $1,574 $1,625

C—131.2 Medically Needy and Parents and Caretaker Relatives Medicaid

Revision 15-4; Effective October 1, 2015

TA 31, TP 08, TP 32, TP 56 and TA 86

- - TP 08, TA 31 and TA 86
Family Size TP 32 and TP 56 One Parent Two Parents
1 $104 $103 N/A
2 $216 $196 $161
3 $275 $230 $251
4 $308 $277 $285
5 $357 $310 $332
6 $392 $356 $367
7 $440 $389 $412
8 $475 $441 $447
9 $532 $476 $500
10 $567 $527 $535
11 $624 $562 $587
12 $659 $613 $622
13 $716 $648 $675
14 $751 $700 $710
15 $808 $734 $762
Per each additional member $57 $52 $52

C—131.3 Transitional Medicaid

Revision 22-2; Effective April 1, 2022

TP 07

Family Size 185% FPL
(3-1-22)
TP 07
1 $2,096
2 $2,823
3 $3,551
4 $4,279
5 $5,006
6 $5,734
7 $6,462
8 $7,189
9 $7,917
10 $8,645
11 $9,372
12 $10,100
13 $10,828
14 $11,555
15 $12,283
For each additional person $728

C—131.4 Standard MAGI Income Disregard

Revision 22-2; Effective April 1, 2022

Five Percentage Points of FPL

Family Size 2022 Monthly
Disregard Amount

1

$56.65

2

$76.30

3

$96.00

4

$115.65

5

$135.30

6

$155.00

7

$174.65

8

$194.30

9

$214.00

10

$233.65

11

$253.30

12

$273.00

13

$292.65

14

$312.30

15

$332.00

For each additional person

$19.70

C—131.5 IRS Monthly Income Thresholds

Revision 22-2; Effective April 1, 2022

Each year, the Internal Revenue Service (IRS) establishes income thresholds for earned and unearned income. People whose income (earned, unearned, or a combination) exceeds the federal income tax filing threshold are expected by the IRS to file a federal income tax return under federal law. The IRS monthly income thresholds are used to determine if a person’s income must be counted when calculating Modified Adjusted Gross Income (MAGI) financial eligibility, as explained in A-1341, Income Limits and Eligibility Tests, for Medical Programs, Step 3.

Determining whether a person is required to file a federal income tax return is determined by comparing the specified income types to the IRS thresholds in the following table.

Type of
Income
2022
Threshold
Apply Threshold Value in Form H1042,
Modified Adjusted Gross Income (MAGI)
Worksheet: Medicaid and CHIP
Unearned Income $91.67
  • Page 4-6, Step 3, Part 7
  • Page 4-6, Step 3, Part 9
Earned Income $1,045.83
  • Page 4-6, Step 3, Part 8