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)