Table G: PIL, NHHPP/NHHPP-M, EMA, CM, CSD, Pregnant Women MA, FPEC MA, and Expanded CM SR 19-06, 01/19 (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

$1,346

$1,872

$1,983

$1,983 - $3,218

2

$675

$1,825

$2,538

$2,689

$2,689 - $4,362

3

$683

$2,304

$3,204

$3,395

$3,395 - $5,507

4

$691

$2,782

$3,870

$4,100

$4,100 - $6,652

5

$698

$3,261

$4,536

$4,806

$4,806 - $7,797

6

$779

$3,740

$5,202

$5,511

$5,511 - $8,942

7

$842

$4,219

$5,868

$6,217

$6,217 - $10,086

8

$935

$4,698

$6,534

$6,923

$6,923 - $11,231

9

$987

$5,176

$7,200

$7,628

$7,628 - $12,376

10

$1,064

$5,655

$7,866

$8,334

$8,334 - $13,521

11

$1,151

$6,134

$8,532

$9,039

$9,039 - $14,666

12

$1,223

$6,613

$9,198

$9,745

$9,745 - $15,810

For each additional person add:

$67

$479

$666

$706

$706 - $1,145

 

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)