Appendix A1 ABD Financial Limits 2008 | Medicaid

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	$104,400 + 2000 = $106,400.00	1-08

CHART A1.2 - ABD MEDICAID NET INCOME LIMITS (GROSS - $20)

Type Limit

Individual Limit

Couple Limit

Effective Date

AMN

All

$317

$375

10-90

FBR

(SSI Limit)

$637

$956

1-08

$424.67

$637

N/A

$30

N/A

Medicaid CAP

$1911

$3822

1-08

QDWI

$3552

$4752

3-08

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

$3552

N/A

$3552

N/A

QMB

$867

$1167

4-08

SLMB

$1040

$1400

4-08

QI-1

$1170

$1575

3-08

CHART A1.3 - TRANSFER OF RESOURCE PENALTY DETERMINATION
Averaging Nursing Home Private Pay Billing Rate	$4614.90	4-08

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	$232.33	$338.67	$318.67	1-08
FBR	$232.33	$338.67	$318.67	1-08
QMB	N/A	N/A	$395.56	4-08
SLMB	N/A	N/A	$473.33	4-08
QI-1	N/A	N/A	$531.67	3-08

CHART A1.5 - SUBSTANTIAL GAINFUL ACTIVITY
Category	Income Limit	Effective Date
Non-Blind individuals	$860	1-06
Blind individuals	$1450	1-06

CHART A1.6 – BREAK-EVEN POINTS
Living Arrangement	Earned Income		Unearned Income		Effective Date
Living Arrangement	Individual	Couple	Individual	Couple	Effective Date
A	$1271	$1873	$603	$904	1-06
B	$869	$1271	$402	$603	1-06
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	11/04

A1.8 – MEDICARE EXPENSES

Medicare Part B Premium rate: $96.40 (effective 1-08).

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	$2610	1-08
Dependent Family Member Need Standard	$1770	4-08

HOUSEHOLD SIZE	100%	135%	150%	EFF. DATE
1	$10,400.00	$14,040.00	$15,600.00	2008
2	14,000.00	18,900.00	21,000.00
3	17,600.00	23,760.00	26,400.00
4	21,200.00	28,620.00	31,800.00
5	24,800.00	33,480.00	37,200.00

The FPL (100% level) is increased by $3,600 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 Re-imbursement 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 – 2/1/07 – 03/31/2008
	50.5 cents per mile – effective 04/01/2008