Appendix A1 ABD Financial Limits 2002

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

$89,280 + 2000 =

$91,280.00

1-02
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

$545

$817

1-02

B

$363.34

$545

C

$545

N/A

D

$30

N/A

Medicaid CAP

D

$1635

$3270

1-02

QDWI

A

$3019

$4045

3-02

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

C

$3019

N/A

D

$3019

N/A

QMB

A

$739

$995

4-02

SLMB

A

$886

$1194

4-02

QI-1

A

$997

$1344

3-02

QI-2

A

$1293

$1742

3-02
CHART A1.3 - TRANSFER OF RESOURCE PENALTY DETERMINATION

Averaging Nursing Home Private Pay Billing Rate

$3131

4-02
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

$201.66

$292.33

$273

1-02

FBR

$201.66

$292.33

$273

1-02

QDWI

N/A

N/A

$670

3-02

QMB

N/A

N/A

$339

4-02

SLMB

N/A

N/A

$405

4-02

QI-1

N/A

N/A

$455

3-02

QI-2

N/A

N/A

$588

3-02

QI-2 Refund Amount is $3.91 effective 1-02.

Medicare Part B Premium rate is $54.00 effective 1-02.

Maximum earnings for substantial gainful activity (SGA) are $780.00 per month.

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

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

$90

Effective 1-92

(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

an individual in MRWP

the current Medicaid Cap
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

$2232

1-02

Dependent Family Member Need Standard

$1513

4-02