Table G: Medically Needy Medical Assistance Net Income Limits and Percentages of Poverty Guidelines SR 17-14, 03/17 (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 |
$1,337 |
$1,860 |
$1,970 |
$1,970 - $3,196 |
2 |
$675 |
$1,800 |
$2,504 |
$2,653 |
$2,653 - $4,304 |
3 |
$683 |
$2,264 |
$3,149 |
$3,336 |
$3,336 - $5,412 |
4 |
$691 |
$2,727 |
$3,793 |
$4,018 |
$4,018 - $6,519 |
5 |
$698 |
$3,190 |
$4,437 |
$4,701 |
$4,701 - $7,627 |
6 |
$779 |
$3,654 |
$5,082 |
$5,384 |
$5,384 - $8,735 |
7 |
$842 |
$4,117 |
$5,726 |
$6,067 |
$6,067 - $9,843 |
8 |
$935 |
$4,580 |
$6,371 |
$6,749 |
$6,749 - $10,950 |
9 |
$987 |
$5,043 |
$7,015 |
$7,432 |
$7,432 - $12,058 |
10 |
$1,064 |
$5,507 |
$7,659 |
$8,115 |
$8,115 - $13,166 |
11 |
$1,151 |
$5,970 |
$8,304 |
$8,798 |
$8,798 - $14,273 |
12 |
$1,223 |
$6,433 |
$8,948 |
$9,480 |
$9,480 - $15,381 |
For each additional person add: |
$67 |
$464 |
$645 |
$683 |
$683 - $1,108 |
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)