Table G: Medically Needy Medical Assistance Net Income Limits and Percentages of Poverty Guidelines SR 14-14, 03/14 (MAM-A) |
Assistance Group Size |
PIL |
Children’s Medicaid (CM), Children with Severe Disabilities (CSD), Pregnant Women MA, and FPEC MA < 196% |
Expanded (CM) > 196%, but < 318% |
1 |
$591 |
$1,907 |
$1,907 - $3,093 |
2 |
$675 |
$2,570 |
$2,570 - $4,169 |
3 |
$683 |
$3,233 |
$3,233 - $5,245 |
4 |
$691 |
$3,896 |
$3,896 - $6,321 |
5 |
$698 |
$4,559 |
$4,559 - $7,397 |
6 |
$779 |
$5,222 |
$5,222 - $8,473 |
7 |
$842 |
$5,885 |
$5,885 - $9,548 |
8 |
$935 |
$6,549 |
$6,549 - $10,624 |
9 |
$987 |
$7,212 |
$7,212 - $11,700 |
10 |
$1,064 |
$7,875 |
$7,875 - $12,776 |
11 |
$1,151 |
$8,538 |
$8,538 - $13,852 |
12 |
$1,223 |
$9,201 |
$9,201 - $14,928 |
For each additional person add: |
$67 |
$664 |
$664 - $1,076 |
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)