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SCDHHS MPPM

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103.01 Optional Coverage for (Pregnant) Women/Infants – OCWI, Family Planning – FP, and Transitional Medicaid (Eff. 03/01/09)

(185% of Federal Poverty Level)


Family Size

Monthly Income

Annual Income
1 1,670.00 20,036.00
2 2,247.00 26,955.00
3 2,823.00 33,874.00
4 3,400.00 40,793.00
5 3,976.00 47,712.00
6 4,553.00 54,631.00
7 5,130.00 61,550.00
8 5,706.00 68,469.00
Each Additional Member 577.00 6,919.00

For each additional family member, add $6,919 to the annual income.

Divide by 12 and round up to the next whole dollar for the monthly income.

103.02 Healthy Connections Programs for Children Up to Age 19 (Eff. 03/01/09)

Family Size 100% FPL 133% FPL 150% FPL 185% FPL 200% FPL
1 903.00 1,201.00 1,354.00 1,670.00 1,805.00
2 1,215.00 1,615.00 1,822.00 2,247.00 2,429.00
3 1,526.00 2,030.00 2,289.00 2,823.00 3,052.00
4 1,838.00 2,444.00 2,757.00 3,400.00 3,675.00
5 2,150.00 2,859.00 3,224.00 3,976.00 4,299.00
6 2,461.00 3,273.00 3,692.00 4,553.00 4,922.00
7 2,773.00 3,688.00 4,159.00 5,130.00 5,545.00
8 3,085.00 4,102.00 4,627.00 5,706.00 6,169.00
Each Additional Member 312.00 415.00 468.00 577.00 624.00

For family sizes over 8, add the amount shown for each extra person to income limit for 8.

103.03 Low Income Families – LIF (Eff. 11/01/09)


Number in
Budget Group

Gross Income Limit
Net Income Limit
1 $835 $452
2 1,124 608
3 1,412 764
4 1,700 920
5 1,988 1,076
6 2,277 1,231
7 2,565 1,387
8 2,853 1,543

For family sizes over 8, add $156 for each extra person to net income limit for 8. To calculate the gross income limit, multiply the net income limit by 185%.

103.04 Regular Foster Care – RFC (Eff. 11/01/09)


Number in Budget Group
Monthly Income Limit

1
$452
align = "center"|
2
608

3
764

4
920

5
1,076

6
1,231

7
1,387

8
1,543

For family sizes over 8, add $156 for each extra person to net income limit for 8. To calculate the gross income limit, multiply the net income limit by 185%.

103.05 Aged, Blind and Disabled – ABD (Eff. 03/01/09)

(100% of Federal Poverty Level)


FAMILY SIZE

MONTHLY INCOME

ANNUAL INCOME
1
2
$903
1,215
:$10,830
:14,570

103.06 Specified Low Income Beneficiaries – SLMB
Qualifying Individual – QI (Eff. 03/01/09)

(120% and 135% of Federal Poverty Level)

Family Size SLMB
120%
QI
135%

1 (Individual)
$1,083 $1,219

2 (Couple)
1,457 1,640

103.07 General Hospital (GH), Nursing Home (NH), Katie Beckett (TEFRA), Home and Community Based Services (HCBS) (Eff. 01/01/09)

(300% of Federal Benefit Rate)

Family Size Monthly Income Limit
Individual $ 2,022
Spousal Allocation (NH and HCBS only) $ 2,739

103.07A Current Average Monthly Private Pay Rate (Eff. 11/01/09)

Current Average Monthly Private Pay Rate $5,379.80

103.08 Breast and Cervical Cancer Program (BCCP)
Gap Assistance Pharmacy Program for Seniors (GAPS) Qualified Disabled Working Individuals (QDWI) (Eff. 03/01/09)

(200% of Federal Poverty Level)


FAMILY SIZE

MONTHLY INCOME

ANNUAL INCOME
1 1,805.00 21,660.00
2 2,429.00 29,140.00
3 3,052.00 36,620.00
4 3,675.00 44,100.00
5 4,299.00 51,580.00
6 4,922.00 59,060.00
7 5,545.00 66,540.00
8 6,169.00 74,020.00
Each Additional Member 624.00 7,480.00

For each additional member, add $7,480 to the annual income.

Divide by 12 and round up to the next whole dollar for the monthly income.

103.09 Working Disabled – WD (Eff. 03/01/09)

(250% of Federal Poverty Level)


Family Size

Monthly Income

Annual Income
1 2,257.00 27,075.00
2 3,036.00 36,425.00
3 3,815.00 45,775.00
4 4,594.00 55,125.00
5 5,373.00 64,475.00
6 6,153.00 73,825.00
7 6,932.00 83,175.00
8 7,711.00 92,525.00
Each Additional Member 780.00 9,350.00

For each additional family member, add $9,350 to the annual income.

Divide by 12 and round up to the next whole dollar for the monthly income.

103.10 Optional State Supplementation – OSS (Eff. 01/01/09)


Monthly Net Income Limit: $ 1,157

Personal Needs Allowance:$57
(+ $20 income disregard if applicable)

103.11 Substantial Gainful Activity – SGA (Eff. 01/01/09)

Blind Individual $1,640
Non–Blind Individual $980

103.12 Program Resource Limits (Eff. 01/01/10)

Program Individual Limit Couple Limit
Chapter 203
Optional Coverage for (Pregnant) Women and Infants (OCWI)
$30,000 per Budget Group
Chapter 204
Partners for Healthy Children (PHC)
$30,000 per Budget Group
Chapter 205
Low Income Families (LIF)
Refugee Assistance Program (RAP)
$30,000 per Budget Group
Chapter 207
Children Under Age 21 in Special Living Arrangements
$30,000 per Budget Group
Chapter 303
ABD, QMB, SLMB
$6,600 $9,910
Chapter 304
Nursing Home, HCBS, General Hospital
$2,000 $66,480
Spousal share for community spouse. Refer to MPPM 304.14
Chapter 305 TEFRA $2,000 N/A
Chapter 306
Qualifying Individual (QI)
$6,600 $9,910
Chapter 307 Working Disabled $6,600 N/A
Chapter 308 Qualified Disabled Working Individual $6,600 $9,910
Chapter 403 Optional State Supplementation $2,000 N/A
Chapter 404
Pass–along
$2,000 $3,000
Chapter 405 Retroactive SSI $2,000 $3,000
Chapter 502
Gap Assistance Pharmacy Program for Seniors (GAPS)
N/A N/A

103.13 Social Security Cost–of–Living Adjustment – COLA and Supplemental Security Income – SSI Federal Benefit Rate (Eff. 01/01/09)

  EFFECTIVE
DATE
01/01 01/02 01/03 01/04 01/05 01/06 01/07 01/08 01/09

COST–OF–LIVING ADJUSTMENT
(COLA)

3.5%

2.6%

1.4%

2.1%

2.7%

4.1%

3.3%

2.3%

5.8%

INDIVIDUAL

FEDERAL BENEFIT RATE (FBR) IN OWN HOUSEHOLD

531.00

545.00

552.00

564.00

579.00

603.00

623.00

637.00

674.00

VALUE OF THE 1/3 REDUCTION (VTR)

177.00

181.66

184.00

188.00

193.00

201.00

207.66

212.33

224.66

HOUSEHOLD OF ANOTHER

354.00

363.34

368.00

376.00

386.00

402.00

415.34

424.67

449.34

COUPLE

FBR IN OWN HOUSEHOLD

796.00

817.00

829.00

846.00

869.00

904.00

934.00

956.00

1,011.00

VTR

265.33

272.33

276.33

282.00

290.00

301.33

311.33

318.66

337.00

HOUSEHOLD OF ANOTHER

530.67

544.67

552.67

564.00

579.00

602.67

622.67

637.34

674.00

INELIGIBLE CHILD

ALLOCATION

265.00

272.00

277.00

282.00

290.00

301.00

311.00

319.00

337.00

Social Security Cost–of–Living Adjustment – COLA and

Supplemental Security Income – SSI Federal Benefit Rate

with Effective Dates: 01/92 through 01/00

  EFFECTIVE
DATE
01/92 01/93 01/94 01/95 01/96 01/97 01/98 01/99 01/00

COST–OF–LIVING ADJUSTMENT
(COLA)

3.7%

3.0%

2.6%

2.8%

2.6%

2.9%

2.1%

1.3%

2.5%

INDIVIDUAL

FEDERAL BENEFIT RATE (FBR) IN OWN HOUSEHOLD

422.00

434.00

446.00

458.00

470.00

484.00

494.00

500.00

513.00

VALUE OF THE 1/3 REDUCTION (VTR)

140.66

144.66

148.66

152.66

156.66

161.33

164.66

166.66

171.00

HOUSEHOLD OF ANOTHER

281.34

289.34

297.34

305.34

313.34

322.67

329.34

333.34

342.00

COUPLE

FBR IN OWN HOUSEHOLD

633.00

652.00

669.00

687.00

705.00

726.00

741.00

751.00

769.00

VTR

211.00

217.33

223.00

229.00

235.00

242.00

247.00

250.33

256.33

HOUSEHOLD OF ANOTHER

422.00

434.67

446.00

458.00

470.00

484.00

494.00

500.67

512.67

INELIGIBLE CHILD

ALLOCATION

211.00

218.00

223.00

229.00

235.00

242.00

247.00

251.00

256.00

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