Table G: Medically Needy Medical Assistance Net Income Limits and Percentages of Poverty Guidelines SR 14-04, 01/14 (MAM-A)

Assistance Group Size

PIL

MCPW, FPMA and EMA

< 196%

Children’s Medicaid (CM)

< 318%

1

$591

$1,877

$3,045

2

$675

$2,534

$4,111

3

$683

$3,190

$5,176

4

$691

$3,847

$6,241

5

$698

$4,504

$7,307

6

$779

$5,160

$8,372

7

$842

$5,817

$9,437

8

$935

$6,473

$10,502

9

$987

$7,130

$11,568

10

$1,064

$7,787

$12,633

11

$1,151

$8,443

$13,698

12

$1,223

$9,100

$14,764

For each additional person add:

$67

$620

$1,066

References: He-W 601.05(q), He-W 601.06(s), He-W 602.04, He-W 606.89, He-W 626, He-W 641.02, He-W 641.06, He-W 641.07, He-W 664.02(b), He-W 658.04, He-W 678.01, He-W 606.98, RSA 126-A:4-c, RSA 167:6,VII, RSA 167:68, Section 1902(a), (f), & (l) of the SSA [42 USC 1396a], Section 1903(f)(1)(A)-(C) of the SSA [42 USC 1396b], Section 1905(a), (n) & (u)(2) of the SSA [42 USC 1396d], Section 1931 of the SSA [42 USC 1396u-1], Section 2101 of the SSA [42 U.S.C. 1397aa], 42 CFR 435.4, 42 CFR 435.301, 42 CFR 435.911, 45 CFR 233.20, 42 USC 1396r-1c, 42 USC 9902(2)