Appendix A1 ABD Financial Limits 2025

Georgia State Seal

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

ABD Financial Limits

Effective Date:

June 2025

Chapter:

Appendix A1

Policy Number:

Appendix A1

Previous MT Number(s):

MT 72

Updated or Reviewed in MT:

MT 76
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

$9,660

$14,470

N/A

1-25

QDWI

$4000

$6000

N/A

1-89

Spousal Impoverishment

N/A

N/A

$157,920 + 2000 = $159,920

1-25
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

$967

$1450

1-25

B

$644.67

$966.67

C

$967

N/A

D

$30

N/A

Medicaid CAP

D

$2901

$5802

1-25

QDWI

A

$5,302

$7,135

3-25

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

C

$5,302

N/A

D

$5,302

N/A

QMB

A

$1,305

$1,763

4-25

SLMB

A

$1,565

$2,115

4-25

QI-1

A

$1,761

$2,380

3-25
CHART A1.3 - TRANSFER OF RESOURCE PENALTY DETERMINATION

Averaging Nursing Home Private Pay Billing Rate

$10,965.00

4-25
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

$342.33

$503.33

$483.33

1-25

FBR

$342.33

$503.33

$471.66

1-25

QMB

N/A

N/A

$594.33

4-25

SLMB

N/A

N/A

$711.66

4-25

QI-1

N/A

N/A

$800.00

3-25
CHART A1.5 - SUBSTANTIAL GAINFUL ACTIVITY
Category Income Limit Effective Date

Non-Blind individuals

$1620

1-25

Blind individuals

$2700
CHART A1.6 – BREAK-EVEN POINTS

Living Arrangement

Earned Income

Unearned Income

Effective Date

Individual

Couple

Individual

Couple

A

$2019

$2985

$987

$1470

1-25

B

$1374.34

$2018.34

$664.67

$986.67

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

$8,133.00 (31 days)

04-25

ICF/ID

$36,577.00 (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)
$185.00* (or higher depending on income) (effective 2025)

Effective 01/2016 Medicare Part B Premium rates may vary. Check BENDEX for applicable rate. *Most SSA recipients will pay less that this amount, $185.00 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

$3,948.00

1-25

Dependent Family Member Need Standard

$2,645.00

4-25
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 - 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

2025 - 39.99
A1.13 – 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 - 12/31/24

70.0 cents per mile - 01/01/2025 - present