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)