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 |
|
| Earned Income | $1,033.33 |
|