Table G: PIL, Granite Advantage, EMA, CM, CSD, Pregnant Women MA, FPEC MA, and Expanded CM SR 23-14 Dated 03/23

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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

$888

$1,616

$2,248

$2,382

$2,382 - $3,864

2

$1033

$2,186

$3,041

$3,221

$3,221 - $5,226

3

$1177

$2,756

$3,833

$4,061

$4,061 - $6,588

4

$1311

$3,325

$4,625

$4,900

$4,900 - $7,950

5

$1444

$3,895

$5,418

$5,740

$5,740 - $9,313

6

$1611

$4,465

$6,210

$6,580

$6,580 - $10,675

7

$1744

$5,035

$7,003

$7,419

$7,419 - $12,037

8

$1944

$5,604

$7,795

$8,259

$8,259 - $13,399

9

$2055

$6,174

$8,588

$9,098

$9,098 - $14,761

10

$2222

$6,744

$9,380

$9,938

$9,938 - $16,123

11

$2411

$7,313

$10,172

$10,777

$10,777 - $17,485

12

$2566

$7,883

$10,965

$11,617

$11,617 - $18,847

For each additional person add:

 

$570

$793

$840

$840 - $1,363

 

*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)