Table C, TANF Medical Assistance Net Income Limits and Percentages of Poverty Level SR 05-01, 01/05 (FAM-A)

Assistance Group Size

PIL

QMB

< 100%

MCPW EMA
Healthy Kids-Gold:
age 0-19

< 185%

Healthy Kids-Gold:

Infants age 0-1

> 185% < 300%

1

$ 593

$ 776

$1,436

$ 2,328

2

$ 675

$1,041

$1,926

$ 3,123

3

$ 683

$1,306

$2,416

$ 3,918

4

$ 691

$1,571

$2,907

$ 4,713

5

$ 698

$1,836

$3,397

$ 5,508

6

$ 779

$2,101

$3,887

$ 6,303

7

$ 842

$2,366

$4,377

$ 7,098

8

$ 935

$2,631

$4,868

$ 7,893

9

$ 987

$2,896

$5,358

$ 8,688

10

$1,064

$3,161

$5,848

$ 9,483

11

$1,151

$3,426

$6,338

$10,278

12

$1,223

$3,691

$6,829

$11,073

For each additional person add:

$ 67

$ 265

$ 491

$ 795