Table G: PIL, NHHPP/NHHPP-M, EMA, CM, CSD, Pregnant Women MA, FPEC MA, and Expanded CM SR 18-14, 03/18 (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)