Appendix A1 ABD Financial Limits 2001

CHART A1.1 - ABD MEDICAID RESOURCE LIMITS
Type Limit Individual Limit Couple Limit LA-D Individual With a Community Spouse Effective Date

SSI

$2000

$3000

N/A

7-88

AMN

$2000

$4000

N/A

4-90

QMB/SLMB/QIs/ QDWI

$4000

$6000

N/A

1-89

Spousal Impoverishment

N/A

N/A

$87,000 + 2000 =

$89,000.00

1-01
CHART A1.2 - ABD MEDICAID INCOME LIMITS
Type Limit LA Individual Limit Couple Limit Effective Date

AMN

All

$317

$375

10-90

FBR

(SSI Limit)

A

$530 / $531

$796/ $796

1-01/8-01

B

$353.34/ $354

$530/ $530.67

C

$530/ $531

N/A

D

$30

N/A

Medicaid CAP

D

$1590/ $1593

$3180/ $3186

1-01/8-01

QDWI

A

$1392/$1432

$1876/$1935

3-00/3-01

Effective 3-98, ISM no longer applies to this COA eliminating LA-B.

C

$1432

N/A

D

$1432

N/A

QMB

A

$696/$716

$938/$968

4-00/4-01

SLMB

A

$836/$859

$1126/$1161

4-00/4-01

QI-1

A

$940/$967

$1267/$1307

3-00/3-01

QI-2

A

$1218/$1253

$1642/$1694

3-00/3-01
CHART A1.3 - TRANSFER OF RESOURCE PENALTY DETERMINATION

Averaging Nursing Home Private Pay Billing Rate

$2930/$3042

4-96/4-01
CHART A1.4 - PRESUMED MAXIMUM VALUE (PMV) OF ISM AND LIVING ALLOWANCE TO EACH INELIGIBLE CHILD
Income Limit PMV for an Individual PMV for a Couple Living Allowance Effective Date

AMN

$196.66/$197

$285.33

$266/$266

1-01

FBR

$196.66/$197

$285.33

$266/$266

1-01

QDWI

N/A

N/A

$625.33/$651.67

3-00/3-01

QMB

N/A

N/A

$313/$329.34

4-00/4-01

SLMB

N/A

N/A

$375.33/$393.67

4-00/4-01

QI-1

N/A

N/A

$422.33/$443

3-00/3-01

QI-2

N/A

N/A

$547.33/$571.34

3-00/3-01

QI-2 Refund Amount is $3.09 effective 01-01.

Medicare Part B Premium rate is $50.00 effective 01-01.

CHART A1.5 - PERSONAL NEEDS ALLOWANCES (PNA) FOR AN LA-D RECIPIENT
IF the LA-D Recipient is THEN use the following as the PNA in the Patient Liability/Cost Share Budget:

an individual in a nursing home

$30

Effective 1-92

a VA pensioner or his/her surviving spouse in a nursing home who has dependents

$30

Effective 1-92

a VA pensioner or his/her surviving spouse in a nursing home who has no dependents

$90

Effective 1-92
The VA check for these individuals is reduced to the amount of the PNA, regardless of other income.

(Effective 1-93 for the Surviving Spouse)

an individual in CCSP

the current amount of the Individual FBR for LA-A

an individual in ICWP

the current amount of the Community Spouse Maintenance Need Standard
CHART A1.6 - NEED STANDARDS FOR DIVERSION OF INCOME TO A COMMUNITY SPOUSE OR DEPENDENT FAMILY MEMBER IN A PATIENT LIABILITY/COST SHARE BUDGET
Diversion Standard Amount Effective Date

Community Spouse Maintenance Need Standard

$2175

1-01

Dependent Family Member Need Standard

$1472

1-01