Appendix A1 ABD Financial Limits 2024

Georgia State Seal

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

ABD Financial Limits

Effective Date:

July 2024

Chapter:

Appendix A1

Policy Number:

Appendix A1

Previous Policy Number(s):

Updated or Reviewed in MT:

MT-72
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

$9,430

$14,130

N/A

1-24

QDWI

$4000

$6000

N/A

1-89

Spousal Impoverishment

N/A

N/A

$154,140 + 2000 = $156,140

1-24
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

$943

$1415

1-24

B

$629

$943

C

$943

N/A

D

$30

N/A

Medicaid CAP

D

$2829

$5658

1-24

QDWI

A

$5,105

$6,899

3-24

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

C

$5,105

N/A

D

$5,105

N/A

QMB

A

$1,255

$1,704

4-24

SLMB

A

$1,506

$2,044

4-24

QI-1

A

$1,695

$2,300

3-24
CHART A1.3 - TRANSFER OF RESOURCE PENALTY DETERMINATION

Averaging Nursing Home Private Pay Billing Rate

$10,025.00

4-24
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

$334.33

$491.66

$471.66

1-24

FBR

$334.33

$491.66

$471.66

1-24

QMB

N/A

N/A

$574.66

4-24

SLMB

N/A

N/A

$688.00

4-24

QI-1

N/A

N/A

$773.00

3-24
CHART A1.5 - SUBSTANTIAL GAINFUL ACTIVITY
Category Income Limit Effective Date

Non-Blind individuals

$1550

1-24

Blind individuals

$2590
CHART A1.6 – BREAK-EVEN POINTS

Living Arrangement

Earned Income

Unearned Income

Effective Date

Individual

Couple

Individual

Couple

A

$1971

$2915

$963

$1435

1-24

B

$1342.34

$1971.68

$648.67

$963.34

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

$6,659.73 (31 days)

04-24

ICF/ID

$32,736.00 (31 days)
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)
$174.70* (or higher depending on income) (effective 2024)

Effective 01/2016 Medicare Part B Premium rates may vary. Check BENDEX for applicable rate. *Most SSA recipients will pay less that this amount.
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

$3,853.50

4-24

Dependent Family Member Need Standard

$2,555

4-24
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

$15,060.00

$20,331.00

$22,590.00

2024

2

$20,440.00

$27,594.00

$30,660.00

3

$25,820.00

$34,857.00

$38,730.00

4

$31,200.00

$42,120.00

$46,800.00

5

$36,580.00

$49,383.00

$54,870.00

The FPL (100% level) is increased by $5,380 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 Eff. Date

Resource Limit

None

Individual - $17,200 Couple - $34,360

2024

Income Limit

Full Medicaid

Less than 150% of FPL

Monthly Premium

$0

Sliding Scale

Deductible Per Year

$0

$0

Coinsurance up to $7400

Out of Pocket

$1.55 - $4.60 Copay

15% Coinsurance

Catastrophic 5% or Copay

$0

$4.50 - $11.20 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

2024 - 44.23
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 - 12/31/23

67.0 cents per mile - 01/01/24 - present