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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