Appendix A1 ABD Financial Limits 2013

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

$7080

$11,800

N/A

1-13

QDWI

$4000

$6000

N/A

1-89

Spousal Impoverishment

N/A

N/A

$115,920 + 2000 = $117,920.00

1-13
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

$710

$1066

1-13

B

$473.33

$710

C

$710

N/A

D

$30

N/A

Medicaid CAP

D

$2130

$4260

1-13

QDWI

A

$3899

$5235

3-13

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

C

$3899

N/A

D

$3899

N/A

QMB

A

$958

$1293

4-13

SLMB

A

$1149

$1551

4-13

QI-1

A

$1293

$1745

3-13
CHART A1.3 - TRANSFER OF RESOURCE PENALTY DETERMINATION

Averaging Nursing Home Private Pay Billing Rate

$5627.08

4-13
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

$256.67

$375.33

$355.33

1-13

FBR

$256.67

$375.33

$355.33

1-13

QMB

N/A

N/A

$417.00

4-13

SLMB

N/A

N/A

$503.00

4-13

QI-1

N/A

N/A

$568.00

3-13
CHART A1.5 - SUBSTANTIAL GAINFUL ACTIVITY
Category Income Limit Effective Date

Non-Blind individuals

$1040

1-13

Blind individuals

$1740
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

$4332.00

05/12

ICF/MR

$8895.00

A1.8 – MEDICARE EXPENSES

Medicare Part B Premium rate: $104.90 (effective 1-13).

Medicare Part D Base Premium rate: 31.17 (effective January 2013)

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 NOW/COMP

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

$2898.00

1-13

Dependent Family Member Need Standard

$1939.00

4-13
HOUSEHOLD SIZE 100% 135% 150% EFF. DATE

1

$11,490.00

$15,512.00

$17,235.00

2013

2

15,510.00

20,939.00

23,265.00

3

19,530.00

26,366.00

29,295.00

4

23,550.00

31,793.00

35,325.00

5

27,570.00

37,220.00

41,355.00

The FPL (100% level) is increased by $4,020 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 - $8,580

Non Q Track Couple - $13,620

Individual - $13,300 Couple - $26,580

2013

Income Limit

Full Medicaid

Q Track

or

Less than 135% of FPL

Less than 150% of FPL

Monthly Premium

$0

$0

Sliding Scale

Deductible Per Year

$0

Up to $66.00

Up to $66.00

Coinsurance up to $3600 Out of Pocket

$1.15 - $3.50 Copay

$2.65 - $6.60 Copay

15% Coinsurance

Catastrophic 5% or $2/$5 Copay

$0

$0

$2.65 - $6.60 Copay

Low-Income Part D Premium Subsidy Amount

2010 – 29.62
2011 – 32.83
2012 – 31.18
2013 – 34.22

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 – 2/1/07 – 03/31/08
50.5 cents per mile – 4/1/08 – 7/31/08
58.5 cents per mile – 8/1/08 – 12/31/08
55 cents per mile – 1/1/09 – 12/31/09
50 cents per mile – 1/1/10 – 12/31/2010
51 cents per mile – 01/01/11 – 04/16/2012
55.5 cents per mile – 04/17/2012 – 12/31/2012
56.5 cents per mile – 01/01/2013 – present