Table G: PIL, Granite Advantage, EMA, CM, CSD, Pregnant Women MA, FPEC MA, and Expanded CM SR19-14, 03/19 (MAM-A)
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Assistance Group Size |
PIL |
Granite Advantage Health Care Program (Granite Advantage) < 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 |
$1,385 |
$1,926 |
$2,041 |
$2,041 - $3,310 |
2 |
$675 |
$1,875 |
$2,607 |
$2,762 |
$2,762 - $4,482 |
3 |
$683 |
$2,365 |
$3,289 |
$3,484 |
$3,484 - $5,653 |
4 |
$691 |
$2,854 |
$3,970 |
$4,206 |
$4,206 - $6,824 |
5 |
$698 |
$3,344 |
$4,652 |
$4,928 |
$4,928 - $7,996 |
6 |
$779 |
$3,834 |
$5,333 |
$5,650 |
$5,650 - $9,167 |
7 |
$842 |
$4,324 |
$6,015 |
$6,372 |
$6,372 - $10,338 |
8 |
$935 |
$4,814 |
$6,696 |
$7,094 |
$7,094 - $11,509 |
9 |
$987 |
$5,304 |
$7,377 |
$7,816 |
$7,816 - $12,681 |
10 |
$1,064 |
$5,794 |
$8,059 |
$8,538 |
$8,538 - $13,852 |
11 |
$1,151 |
$6,284 |
$8,740 |
$9,260 |
$9,260 - $15,023 |
12 |
$1,223 |
$6,774 |
$9,422 |
$9,982 |
$9,982 - $16,195 |
For each additional person add: |
$67 |
$490 |
$682 |
$722 |
$722 - $1,172 |
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)
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