Appendix A1 ABD Financial Limits 2007

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

$101,640 + 2000 = $103,640.00

1-07
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

$623

$934

1-07

B

$415.33

$623

C

$623

N/A

D

$30

N/A

Medicaid CAP

D

$1869

$3738

1-07

QDWI

A

$3489

$4649

3-07

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

C

$3489

N/A

D

$3489

N/A

QMB

A

$851

$1141

4-07

SLMB

A

$1021

$1369

4-07

QI-1

A

$1149

$1541

3-07
CHART A1.3 - TRANSFER OF RESOURCE PENALTY DETERMINATION

Averaging Nursing Home Private Pay Billing Rate

$4358.57

4-07
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

$227

$331.34

$311.34

1-07

FBR

$227

$331.34

$311.34

1-07

QMB

N/A

N/A

$387.00

4-07

SLMB

N/A

N/A

$463.00

4-07

QI-1

N/A

N/A

$520.34

3-07
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: $93.50 (effective 1-07).

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

$2541

1-07

Dependent Family Member Need Standard

$1712

4-07
HOUSEHOLD SIZE 100% 135% 150% EFF. DATE

1

$10,210.00

$13,783.50

$15,315.00

2007

2

13,690.00

18,481.50

20,535.00

3

17,170.00

23,179.50

25,755.00

4

20,650.00

27,877.50

30,975.00

5

24,130.00

32,575.50

36,195.00

The FPL (100% level) is increased by $3,480 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 - $7,620

Non Q Track Couple - $12,190

Individual - $11,710

Couple - $23,410

2007

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

Up to $53.00

Up to $53.00

Coinsurance up to $3600 Out of Pocket

$1 - $3.10 Copay

$2.15 - $5.35 Copay

15% Coinsurance

Catastrophic 5% or $2/$5 Copay

$0

$0

$2.15 - $5.35 Copay

A1.13 – Medically Needy Mileage Reimbursement Rate

48.5 cents per mile – 9/10/05 – 12/31/05
44.5 cents per mile – 1/1/06 – 1/31/07
48.5 cents per mile – effective 2/1/07