Table G: PIL, Granite Advantage, EMA, CM, CSD, Pregnant Women MA, FPEC MA, and Expanded CM SR 23-01 Dated 01/23 (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

$888

$1,507

$2,096

$2,220

$2,220 - $3,602

2

$1033

$2,030

$2,823

$2,991

$2,991 - $4,853

3

$1177

$2,553

$3,551

$3,762

$3,762 - $6,103

4

$1311

$3,076

$4,279

$4,533

$4,533 - $7,354

5

$1444

$3,599

$5,006

$5,304

$5,304 - $8,605

6

$1611

$4,122

$5,734

$6,075

$6,075 - $9,856

7

$1744

$4,646

$6,462

$6,846

$6,846 - $11,107

8

$1944

$5,169

$7,189

$7,617

$7,617 - $12,357

9

$2055

$5,692

$7,917

$8,388

$8,388 - $13,608

10

$2222

$6,215

$8,645

$9,159

$9,159 - $14,859

11

$2411

$6,738

$9,372

$9,930

$9,930 - $16,110

12

$2566

$7,261

$10,100

$10,700

$10,700 - $17,361

For each additional person add:

  

$524

$728

$771

$771 - $1,251

 

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)