C-130, Medical Programs

Body

C—131 Income Limits

Revision 13-3; Effective July 1, 2013

 

C—131.1 Federal Poverty Level (FPL)

Revision 21-2; Effective April 1, 2021

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
(3-1-21)
TP 44, 34, TA 76
144% FPL
(3-1-21)
TP 48, 33, TA 75
198% FPL
(3-1-21)
TP 40, 42, 43, 36, 35, TA 74
1 $1,428 $1,546 $2,126
2 $1,931 $2,091 $2,875
3 $2,434 $2,636 $3,624
4 $2,938 $3,180 $4,373
5 $3,441 $3,725 $5,122
6 $3,944 $4,270 $5,871
7 $4,447 $4,815 $6,620
8 $4,950 $5,360 $7,369
9 $5,453 $5,904 $8,118
10 $5,957 $6,449 $8,868
11 $6,460 $6,994 $9,617
12 $6,963 $7,539 $10,366
13 $7,466 $8,084 $11,115
14 $7,969 $8,628 $11,864
15 $8,473 $9,173 $12,613
For each additional member $504 $545 $750

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 200% FPL
(3-1-21 - 3-19-2021)
TA 41
201% FPL
(3-1-21)
TA 84
202% FPL
(3-1-21)
TA 85
204.2% FPL
(3-20-21)
TA 41
400% FPL
(3-1-21)
TA 77
413% FPL
(3-1-21)
TP 70
1 $2,147 $2,158 $2,169 $2,192 $4,294 $4,433
2 $2,904 $2,918 $2,933 $2,965 $5,807 $5,996
3 $3,660 $3,679 $3,697 $3,737 $7,320 $7,558
4 $4,417 $4,439 $4,461 $4,510 $8,834 $9,121
5 $5,174 $5,200 $5,226 $5,282 $10,347 $10,683
6 $5,930 $5,960 $5,990 $6,055 $11,860 $12,246
7 $6,687 $6,721 $6,754 $6,828 $13,374 $13,808
8 $7,444 $7,481 $7,518 $7,600 $14,887 $15,371
9 $8,200 $8,241 $8,282 $8,373 $16,400 $16,933
10 $8,957 $9,002 $9,047 $9,145 $17,914 $18,496
11 $9,714 $9,762 $9,811 $9,918 $19,427 $20,059
12 $10,470 $10,523 $10,575 $10,690 $20,940 $21,621
13 $11,227 $11,283 $11,339 $11,463 $22,454 $23,184
14 $11,984 $12,044 $12,104 $12,235 $23,967 $24,746
15 $12,740 $12,804 $12,868 $13,008 $25,480 $26,309
For each additional member $757 $761 $765 $773 $1,514 $1,563

 

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 21-2; Effective April 1, 2021

TP 07

Family Size 185% FPL
(3-1-21)
TP 07
1 $1,986
2 $2,686
3 $3,386
4 $4,086
5 $4,786
6 $5,486
7 $6,186
8 $6,886
9 $7,585
10 $8,285
11 $8,985
12 $9,685
13 $10,385
14 $11,085
15 $11,785
For each additional person $700

 

C—131.4 Standard MAGI Income Disregard

Revision 21-2; Effective April 1, 2021

Five Percentage Points of FPL

Family Size 2021 Monthly
Disregard Amount

1

$53.70

2

$72.60

3

$91.50

4

$110.45

5

$129.35

6

$148.25

7

$167.20

8

$186.10

9

$205.00

10

$223.95

11

$242.85

12

$261.75

13

$280.70

14

$299.60

15

$318.50

For each additional person

$18.95

 

C—131.5 IRS Monthly Income Thresholds

Revision 21-2; Effective April 1, 2021

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 expected to be 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
2021
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 $1,033.33
  • Page 4-6, Step 3, Part 8