Appendix A1 ABD Financial Limits 2006

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

SSI/LA-D

$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

$99,540 + 2000 =

$101,540.00

1-06
CHART A1.2 - ABD MEDICAID NET INCOME LIMITS (GROSS - $20)
Type Limit LA Individual Limit Couple Limit Effective Date

AMN

All

$317

$375

10-90

FBR

(SSI Limit)

A

$603

$904

1-06

B

$402

$603

C

$603

N/A

D

$30

N/A

Medicaid CAP

D

$1809

$3618

1-06

QDWI

A

$3352

$4485

3-06

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

C

$3352

N/A

D

$3352

N/A

QMB

A

$817

$1100

4-06

SLMB

A

$980

$1320

4-06

QI-1

A

$1103

$1485

3-06
CHART A1.3 - TRANSFER OF RESOURCE PENALTY DETERMINATION

Averaging Nursing Home Private Pay Billing Rate

$4257.60

4-06
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

$221

$321.34

$301.34

1-06

FBR

$221

$321.34

$301.34

1-06

QMB

N/A

N/A

$373..33

4-06

SLMB

N/A

N/A

$446.67

4-06

QI-1

N/A

N/A

$501.67

3-06
CHART A1.5 - SUBSTANTIAL GAINFUL ACTIVITY
Category Income Limit Effective Date

Non-Blind individuals

$860

1-06

Blind individuals

$1450
CHART A1.6 – BREAK-EVEN POINTS

Living Arrangement

Earned Income

Unearned Income

Effective Date

Individual

Couple

Individual

Couple

A

$1271

$1873

$603

$904

1-06

B

$869

$1271

$402

$603

D

$145

$205

$50

$80

7-88
CHART A1.7 – MONTHLY AVERAGED MEDICAID RATES FOR KATIE BECKETT
Level of Care Monthly Amount Effective Date

Skilled Nursing Facility

$3645

11/04

ICF/MR

$6667

A1.8 – MEDICARE EXPENSES

Medicare Part B Premium rate: $88.50 (effective 1-06).

Medicare Approved Drug Discount Card: up to $30 (effective 6/04)

CHART A1.9 - 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

$50

Effective 7-06

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

$50

Effective 7-06

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 A1.10 - 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

$2488.50

1-06

Dependent Family Member Need Standard

$1670

4-06
CHART A1.11 – FEDERAL POVERTY LEVEL TABLES FOR MEDICARE PART D - LOW INCOME SUBSIDY
HOUSEHOLD SIZE 100% 135% 140% 145% 150% EFF. DATE

1

$9,800.00

$13,230.00

$13,720.00

$14,210.00

$14,700.00

2006

2

13,200.00

17,820.00

18,480.00

19,140.00

19,800.00

3

16,600.00

22,410.00

23,240.00

24,070.00

24,900.00

4

20,000.00

27,000.00

28,000.00

29,000.00

30,000.00

5

23,400.00

31,590.00

32,760.00

33,930.00

35,100.00

The FPL (100% level) is increased by $3,260 for each additional person in the household.

CHART A1.12 – COSTS AND GUIDELINES FOR RECEIPT OF MEDICARE PART D - LOW INCOME SUBSIDY
Group 1 Group 2 Group 3 Eff. Date

Resource Limit

None

Non Q Track Individual -

$6000

Non Q Track Couple -

$9000

Individual - $10,000 Couple - $20,000

2005

Income Limit

100% of

FPL or full Medicaid

Less than 135% of FPL

Less than 150% of FPL

Monthly

Premium

$0

$0

Sliding Scale

Deductible

Per Year

$0

$0

$50.00

Coinsurance

up to $3600 Out of Pocket

$1 - $3

Copay

$2 - $5 Copay

15% Coinsurance

Catastrophic

5% or $2/$5 Copay

$0

$0

$2 - $5 Copay

A1.13 – Medically Needy Mileage Re-imbursement Rate

48.5 cents per mile – 9/10/05 – 12/31/05

44.5 cents per mile – effective 1/1/06