Table C, TANF Medical Assistance Net Income Limits and Percentages of Poverty Level SR 12-14, 03/12 (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

$591

$931

$1,723

$2,793

2

$675

$1,261

$2,333

$3,783

3

$683

$1,591

$2,944

$4,773

4

$691

$1,921

$3,554

$5,763

5

$698

$2,251

$4,165

$6,753

6

$779

$2,581

$4,775

$7,743

7

$842

$2,911

$5,386

$8,733

8

$935

$3,241

$5,996

$9,723

9

$987

$3,571

$6,607

$10,713

10

$1,064

$3,901

$7,217

$11,703

11

$1,151

$4,231

$7,828

$12,693

12

$1,223

$4,561

$8,438

$13,683

For each additional person add:

$67

$330

$611

$990