Table G: Medically Needy Medical Assistance Net Income Limits and Percentages of Poverty Guidelines SR 16-14, 03/16 (MAM-A)

 

Assistance Group Size

PIL

NH Health Protection Program (NHHPP/ NHHPP-M)

< 133%

EMA

< 185%

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

< 196%

Expanded CM

> 196%, but < 318%

1

$591

$1,317

$1,832

$1,941

$1,941 - $3,149

2

$675

$1,776

$2,470

$2,617

$2,617 - $4,246

3

$683

$2,235

$3,108

$3,293

$3,293 - $5,343

4

$691

$2,694

$3,747

$3,969

$3,969 - $6,440

5

$698

$3,153

$4,385

$4,646

$4,646 - $7,537

6

$779

$3,611

$5,023

$5,322

$5,322 - $8,634

7

$842

$4,071

$5,663

$6,000

$6,000 - $9,734

8

$935

$4,532

$6,304

$6,679

$6,679 - $10,836

9

$987

$4,994

$6,946

$7,359

$7,359 - $11,939

10

$1,064

$5,455

$7,587

$8,038

$8,038 - $13,041

11

$1,151

$5,916

$8,228

$8,718

$8,718 - $14,144

12

$1,223

$6,377

$8,870

$9,397

$9,397 - $15,246

For each additional person add:

$67

$462

$642

$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 626.02(b)(3); He-W 641.06; He-W 641.07; He-W 841.02(b); He-W 841.03(c); He-W 841.04(a)(2); He-W 841.05; He-W 841.07(a)(2); He-W 841.08(c)(1); He-W 858.04(b); RSA 126-A:5; XXIII(a); 42 CFR 435.119(b)(5); 42 USC 1396b(f)(1)(A)-(C); 42 USC 1396r-6(b)(3)(A)(iii)(III); 42 USC 9902(2)