Appendix A1 ABD Financial Limits 2023 | Medicaid

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

ABD Financial Limits

Effective Date:

November 2023

Chapter:

Appendix A1

Policy Number:

Appendix A1

Previous Policy Number(s):

Updated or Reviewed in MT:

MT-71

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	$9090	$13,630	N/A	1-23
QDWI	$4000	$6000	N/A	1-89
Spousal Impoverishment	N/A	N/A	$148,620 + 2000 = $150,620.00	1-23

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)

$914

$1371

1-23

$609.34

$914

N/A

$30

N/A

Medicaid CAP

$2742

$5484

1-23

QDWI

$4945

$6659

3-23

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

$4379

N/A

$4379

N/A

QMB

$1215

$1644

4-23

SLMB

$1458

$1972

4-23

QI-1

$1641

$2219

3-23

CHART A1.3 - TRANSFER OF RESOURCE PENALTY DETERMINATION
Averaging Nursing Home Private Pay Billing Rate	$9,584.00	4-23

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	$324.66	$477.00	$477.00	1-23
FBR	$324.66	$477.00	$477.00	1-23
QMB	N/A	N/A	$554.66	4-23
SLMB	N/A	N/A	$664.00	4-23
QI-1	N/A	N/A	$746.00	3-23

CHART A1.5 - SUBSTANTIAL GAINFUL ACTIVITY
Category	Income Limit	Effective Date
Non-Blind individuals	$1470	1-23
Blind individuals	$2460	1-23

CHART A1.6 – BREAK-EVEN POINTS
Living Arrangement	Earned Income		Unearned Income		Effective Date
Living Arrangement	Individual	Couple	Individual	Couple	Effective Date
A	$1913	$2827	$934	$1391	1-23
B	$1303.68	$1913	$629.34	$934	1-23
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	$6,658.49 (31 days)	04-23
ICF/ID	$24,269.59 (31 days)	04-23

A1.8 – MEDICARE EXPENSES

Medicare Part B Premium rate:

$104.90 (effective 1-14)
$121.80 (effective 1-16)
$134.00 (effective 2017 and 2018)
$135.50 (effective 2019)
$144.60 (effective 2020)
$148.50 (effective 2021)
$170.10 (effective 2022)
$164.90 or higher depending on income(effective 2023) (See NOTE below)

Effective 01/2016 Medicare Part B Premium rates may vary check BENDEX for applicable rate.

Most SSA recipients will pay less that this amount (164.90 on average).

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

$70

Effective 7-19

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

$70

Effective 7-19

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 EDWP/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	$3715.50	1-23
Dependent Family Member Need Standard	$2465	4-23

CHART A1.11-TANF Standard of Need (SON)
HOUSEHOLD SIZE	SON	HOUSEHOLD SIZE	SON	EFF. DATE
1	$235.00	7	$672.00	2022
2	$356.00	8	$713.00
3	$424.00	9	$751.00
4	$500.00	10	$804.00
5	$573.00	11	$860.00
6	$621.00	12	$884.00

CHART A1.12 - FEDERAL POVERTY LIMITS
HOUSEHOLD SIZE	100%	135%	150%	EFF. DATE
1	$14,580.00	$19,683.00	$21,870.00	2023
2	$19,720.00	$26,622.00	$29,580.00
3	$24,860.00	$33,561.00	$37,290.00
4	$30,000.00	$40,500.00	$45,000.00
5	$35,140.00	$47,439.00	$52,710.00

The FPL (100% level) is increased by $5,140 for each additional person in the household.

CHART A1.13 – 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 - $10,590 Non-Q Track Couple - $16,630	Individual - $16,660 Couple - $33,240	2023
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	$0.00	104.00
Coinsurance up to $7400 Out of Pocket	$1.45 - $4.30 Copay	$4.15 - $10.35 Copay	15% Coinsurance
Catastrophic 5% or Copay	$0	$0	$4.15 - $10.35 Copay

CHART A1.14 - Low-Income Part D Premium Subsidy Amount
2010 – 29.62
2011 – 32.83
2012 – 31.18
2013 – 34.22
2014 – 29.32
2015 – 26.47
2016 – 25.78
2017 – 26.43
2018 – 24.53
2019 - 25.68
2020 – 25.34
2021 - 29.80
2022 - 32.38
2023 - 37.30

A1.15 – Medically Needy Mileage Reimbursement Rate
48.5 cents per mile – 09/10/05 – 12/31/05
44.5 cents per mile – 01/01/06 – 01/31/07
48.5 cents per mile – 02/01/07 – 03/31/08
50.5 cents per mile – 04/01/08 – 07/31/08
58.5 cents per mile – 08/01/08 – 12/31/08
55.0 cents per mile – 01/01/09 – 12/31/09
50.0 cents per mile – 01/01/10 – 12/31/10
51.0 cents per mile – 01/01/11 – 04/16/12
55.5 cents per mile – 04/17/12 – 12/31/12
56.5 cents per mile – 01/01/13 – 12/31/13
56.0 cents per mile - 01/01/14 – 12/31/14
57.5 cents per mile – 01/01/15 – 12/31/15
54.0 cents per mile – 01/01/16 – 12/31/16
53.5 cents per mile – 01/01/17 - 12/31/17
54.5 cents per mile – 01/01/18 – 12/31/18
58.0 cents per mile – 01/01/19 - 12/31/19
57.5 cents per mile - 01/01/20 - 12/31/20
56.0 cents per mile - 01/01/21 - 12/31/21
58.5 cents per mile - 01/01/22 - 06/30/22
62.5 cents per mile - 07/01/22- 12/31/22
65.5 cents per mile - 01/01/23 - present