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)