Table G: Medically Needy Medical Assistance Net Income Limits and Percentages of Poverty Guidelines SR 14-28, 08/14 (MAM-A)

Assistance Group Size

PIL

NH Health Protection Program (NHHPP/NHHPP-M)

< 133%

Children’s Medicaid (CM), Children with Severe Disabilities (CSD), Pregnant Women MA, and FPEC MA

< 196%

Expanded (CM)

> 196%, but < 318%

1

$591

$1,294

$1,907

$1,907 - $3,093

2

$675

$1,744

$2,570

$2,570 - $4,169

3

$683

$2,194

$3,233

$3,233 - $5,245

4

$691

$2,644

$3,896

$3,896 - $6,321

5

$698

$3,094

$4,559

$4,559 - $7,397

6

$779

$3,544

$5,222

$5,222 - $8,473

7

$842

$3,994

$5,885

$5,885 - $9,548

8

$935

$4,444

$6,549

$6,549 - $10,624

9

$987

$4,894

$7,212

$7,212 - $11,700

10

$1,064

$5,344

$7,875

$7,875 - $12,776

11

$1,151

$5,794

$8,538

$8,538 - $13,852

12

$1,223

$6,244

$9,201

$9,201 - $14,928

For each additional person add:

$67

$450

$664

$664 - $1,076

See also PART 601, Table J, 5% MAGI Deduction, for more information about the special MAGI-specific income deduction that is applied for those individuals who otherwise meet MAGI MA program requirements but fail the income limit test.

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, He-W 841.08, RSA 126-A:4-c, RSA 126-A:5,XXIII-XXVI, 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)