Appendix A1 ABD Financial Limits 2003

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/ QI-1/QDWI

$4000

$6000

N/A

1-89

Spousal Impoverishment

N/A

N/A

$90,660 + 2000 =

$92,660.00

1-03
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

$552

$829

1-03

B

$368

$552

C

$552

N/A

D

$30

N/A

Medicaid CAP

D

$1656

$3312

1-03

QDWI

A

$3059

$4105

3-03

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

C

$3059

N/A

D

$3059

N/A

QMB

A

$749

$1010

4-03

SLMB

A

$898

$1212

4-03

QI-1

A

$1011

$1364

3-03
CHART A1.3 - TRANSFER OF RESOURCE PENALTY DETERMINATION

Averaging Nursing Home Private Pay Billing Rate

$3673

4-03
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

$204

$296.33

$277

1-03

FBR

$204

$296.33

$277

1-03

QDWI

N/A

N/A

$680

3-03

QMB

N/A

N/A

$343.33

4-03

SLMB

N/A

N/A

$410.67

4-03

QI-1

N/A

N/A

$461.33

3-03
CHART A1.5 - SUBSTANTIAL GAINFUL ACTIVITY
Category Income Limit Effective Date

Non-Blind individuals

$800

1-03

Blind individuals

$1330
CHART A1.6 – BREAK-EVEN POINTS

Living Arrangement

Earned Income

Unearned Income

Effective Date

Individual

Couple

Individual

Couple

A

$1,169

$1,723

$552

$829

1-03

B

$801

$1,170.34

$368

$552.67

D

$145

$205

$50

$80

7-88

Medicare Part B Premium rate: $58.70 (effective 1-03).

CHART A1.7 - 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 or Institutionalized Hospice

$30

Effective 01-92

Effective 04-03

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 A1.8 - 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

$2266.50

1-03

Dependent Family Member Need Standard

$1535

4-03