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