Table G: PIL, Granite Advantage, EMA, CM, CSD, Pregnant Women MA, FPEC MA, and Expanded CM SR 20-14, 03/20 (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 |
$1,415 |
$1,968 |
$2,085 |
$2,085 - $3,382 |
2 |
$675 |
$1,911 |
$2,658 |
$2,816 |
$2,816 - $4,569 |
3 |
$683 |
$2,408 |
$3,349 |
$3,548 |
$3,548 - $5,756 |
4 |
$691 |
$2,904 |
$4,040 |
$4,280 |
$4,280 - $6,943 |
5 |
$698 |
$3,401 |
$4,730 |
$5,012 |
$5,012 - $8,131 |
6 |
$779 |
$3,897 |
$5,421 |
$5,743 |
$5,743 - $9,318 |
7 |
$842 |
$4,394 |
$6,112 |
$6,475 |
$6,475 - $10,505 |
8 |
$935 |
$4,890 |
$6,802 |
$7,207 |
$7,207 - $11,692 |
9 |
$987 |
$5,387 |
$7,493 |
$7,938 |
$7,938 - $12,879 |
10 |
$1,064 |
$5,884 |
$8,184 |
$8,670 |
$8,670 - $14,067 |
11 |
$1,151 |
$6,380 |
$8,874 |
$9,402 |
$9,402 - $15,254 |
12 |
$1,223 |
$6,877 |
$9,565 |
$10,134 |
$10,134 - $16,441 |
For each additional person add: |
$67 |
$497 |
$691 |
$732 |
$732 - $1,188 |
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)