Table C: FANF Medical Assistance Net Income Limits and Percentages of Poverty Guidelines SR 13-14, 03/13 (FAM-A)

Assistance Group Size

PIL

QMB

< 100%

MCPW and EMA

< 185%

Children’s Medicaid (CM)

< 300%

1

$591

$958

$1,772

$2,873

2

$675

$1,293

$2,392

$3,878

3

$683

$1,628

$3,011

$4,883

4

$691

$1,963

$3,631

$5,888

5

$698

$2,298

$4,251

$6,893

6

$779

$2,633

$4,871

$7,898

7

$842

$2,968

$5,490

$8,903

8

$935

$3,303

$6,110

$9,908

9

$987

$3,638

$6,730

$10,913

10

$1,064

$3,973

$7,350

$11,918

11

$1,151

$4,308

$7,969

$12,923

12

$1,223

$4,643

$8,589

$13,928

For each additional person add:

$67

$335

$620

$1,005