Table G: Medically Needy Medical Assistance Net Income Limits and Percentages of Poverty Guidelines SR 15-14, 03/15 (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 |
$1,305 |
$1,923 |
$1,923 - $3,120 |
2 |
$675 |
$1,766 |
$2,602 |
$2,602 - $4,222 |
3 |
$683 |
$2,227 |
$3,282 |
$3,282 - $5,324 |
4 |
$691 |
$2,688 |
$3,961 |
$3,961 - $6,427 |
5 |
$698 |
$3,149 |
$4,641 |
$4,641 - $7,529 |
6 |
$779 |
$3,610 |
$5,320 |
$5,320 - $8,632 |
7 |
$842 |
$4,071 |
$6,000 |
$6,000 - $9,734 |
8 |
$935 |
$4,532 |
$6,679 |
$6,679 - $10,836 |
9 |
$987 |
$4,994 |
$7,359 |
$7,359 - $11,939 |
10 |
$1,064 |
$5,455 |
$8,038 |
$8,038 - $13,041 |
11 |
$1,151 |
$5,916 |
$8,718 |
$8,718 - $14,144 |
12 |
$1,223 |
$6,377 |
$9,397 |
$9,397 - $15,246 |
For each additional person add: |
$67 |
$462 |
$680 |
$680 - $1,103 |
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)