Table G: PIL, Granite Advantage, EMA, CM, CSD, Pregnant Women MA, FPEC MA, and Expanded CM SR 21-14, 03/21 (MAM-A)

_____________________________________________________________

Assistance Group Size

PIL

Granite Advantage Health Care Program (Granite Advantage)

< 133%

EMA

< 185%

Children’s Medicaid (CM), Pregnant Women, and FPEC

< 196%

Expanded CM

> 196%, but < 318%

1

$591

$1,428

$1,986

$2,104

$2,104 - $3,414

2

$675

$1,931

$2,686

$2,846

$2,846 - $4,617

3

$683

$2,434

$3,386

$3,587

$3,587 - $5,820

4

$691

$2,938

$4,086

$4,329

$4,329 - $7,023

5

$698

$3,441

$4,786

$5,070

$5,070 - $8,226

6

$779

$3,944

$5,486

$5,812

$5,812 - $9,429

7

$842

$4,447

$6,186

$6,553

$6,553 - $10,632

8

$935

$4,950

$6,886

$7,295

$7,295 - $11,835

9

$987

$5,453

$7,585

$8,036

$8,036 - $13,038

10

$1,064

$5,957

$8,285

$8,778

$8,778 - $14,242

11

$1,151

$6,460

$8,985

$9,520

$9,520 - $15,445

12

$1,223

$6,963

$9,685

$10,261

$10,261 - $16,648

For each additional person add:

$67

$504

$700

$742

$742 - $1,204

 

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)