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)