UPDATED: NOVEMBER 2009
INCOME/RESOURCE TEST
Category
Presumptive
Eligibility for
Pregnant Women
Year
2005 COLA 2.7% inflation rate 2.6% estimate 01/01/05
2006 COLA 4.1% actual FPLs
2007 FPL’s are based on a COLA of 3.3%
1
2
$1,070
$2,139
No Resource Test
Qualified provider makes the presumptive eligibility determination. Cannot
spenddown to become eligible for presumptive eligibility.
2006
100% FPL
200% FPL
100% FPL
200% FPL
100% FPL
200% FPL
100% FPL
200% FPL
100% FPL
200% FPL
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
$1,100
$2,200
$1,141
$2,282
$1,167
$2,334
$1,215
$2,429
$1,070
$2,139
No Resource Test
Same as 2005
No Resource Test
Same as 2005
No Resource Test
Same as 2005
No Resource Test
Same as 2005
No Resource Test
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
$1,595
$1,100
$2,200
$1,141
$2,282
$1,167
$2,334
$1,215
$2,429
$2,139
No Resource Test
No Resource Test
Same as 2005
No Resource Test
Same as 2005
No Resource Test
Same as 2005
2005
100% FPL
200% FPL
100% FPL
200% FPL
100% FPL
200% FPL
100% FPL
200% FPL
200% FPL
If the woman is determined eligible in any month of her pregnancy, she is
guaranteed eligibility for the entire pregnancy (prospectively). If the A/R applies
prior to the birth of the child she is entitled to a 60 day post-partum extension also.
The baby is guaranteed eligibility for one year. If the income is above 200% FPL
the A/R must spenddown to the Medicaid income level.
Same as 2005
No Resource Test
2006
2007
2008
2009
2005
200% FPL
200% FPL
200% FPL
200% FPL
133% FPL
$1,634
$1,702
$1,734
$1, 805
$1,061
$2,200
$2,282
$2,334
$2,429
$1,422
No Resource Test
No Resource Test
No Resource Test
No Resource Test
No Resource Test
2006
2007
2008
2009
2005
133% FPL
133% FPL
133% FPL
133% FPL
100% FPL
$1,087
$1,132
$1,153
$1,201
$798
$1,463
$1,518
$1,552
$1,615
$1,070
No Resource Test
No Resource Test
No Resource Test
No Resource Test
No Resource Test
2006
2007
2008
2009
100% FPL
100% FPL
100% FPL
100% FPL
$817
$851
$867
$903
$1,100
$1,141
$1,167
$1,215
No Resource Test
No Resource Test
No Resource Test
No Resource Test
If the income is above 200% FPL the A/R must spenddown to the Medicaid income
level. One year guaranteed eligibility if mother is in receipt of Medicaid on delivery.
Eligibility can be determined in the 3 months retro to obtain the one year extension.
Same as 2005
Same as 2005
Same as 2005
Same as 2005
If the income is above 133% FPL the A/R must spenddown to the Medicaid income
level, resources will also be evaluated
Same as 2005
Same as 2005
Same as 2005
Same as 2005
If the income is above 100% FPL the A/R must spenddown to the Medicaid income
level, resources will also be evaluated
Same as 2005
Same as 2005
Same as 2005
Same as 2005
2005
2006
2007
2008
2009
Children Age 6
through 18
Special Notes
N/A
N/A
2009
Children Age 1
through 5
Resource Level
100% FPL
200% FPL
2008
Children Under
One
Household Size
2005
2007
Pregnant Women
Income
Compared
PAGE 552
1
2
MRG
UPDATED: NOVEMBER 2009
Category
Year
Income
Compared
PAGE 553
Household Size
Effective 4/1
Singles/Childless
Couples
2005
MA Level
2006
2007
2008
2008
2009
2005
MA Level
MA Level
MA Level
MA Level
MA Level
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
MA Standard
MA Standard
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
MA Standard
MA Standard
MA Level
MA Level
MA Level
MA Level
MA Level
MA Level
2006
2007
2008
Effective 4/1
Low Income
Families
2008
2009
2005
2006
2007
2008
Effective 4/1
SSI-Related
Effective 4/1
2008
2009
2005
2006
2007
2008
2008
2009
Special Notes
2005 COLA 2.7% inflation rate 2.6% estimate 01/01/05
2006 COLA 4.1% actual FPLs
2007 FPL’s are based on a COLA of 3.3%
1
Under 21, ADCrelated and FNP
Resource Level
2
1
2
$667
$975
$4,000
$5,850
FNP parents cannot spenddown
$692
$700
$775
$725
$767
Varies by
County
Varies by
County
Varies by
County
Varies by
County
$673
$706
Varies by
County
Varies by
County
Varies by
County
Varies by
County
$673
$706
$667
$692
$700
$725
$725
$767
$900
$900
$1,067
$1,067
$1,117
Varies by
County
Varies by
County
Varies by
County
Varies by
County
$840
$881
Varies by
County
Varies by
County
Varies by
County
Varies by
county
$840
$881
$975
$900
$900
$1,067
$1,067
$1,117
$4,150
$4,200
$4,250
$13,050
$13,800
$2,000
$5,400
$5,400
$6,400
$19,200
$20,100
$2,000
$2,000
$2,000
Same as 2005
Same as 2005
Same as 2005
Same as 2005
Same as 2005
The A/R cannot spenddown income or resources. Over age 60, resources
are $3000.
Same as 2005
$2,000
$2,000
Same as 2005
$2,000
$2,000
Same as 2005
$13.050
$13,800
$3,000
$19,200
$20,100
$3,000
The A/R cannot spenddown income or resources
The A/R cannot spenddown income or resources
The A/R cannot spenddown income or resources
$3,000
$3,000
Same as 2005
$3,000
$3,000
Same as 2005
$3000
$3000
Same as 2005
$13,050
$13,800
$4,000
$4,150
$4,200
$4,350
$13,050
$13,800
$19,200
$20,100
$5,850
$5,400
$5,400
$6,400
$19,200
$20,100
MRG
The A/R cannot spenddown income or resources.
Household size is always one or two
Same as 2005
Same as 2005
Same as 2005
Same as 2005
Same as 2005
UPDATED: NOVEMBER 2009
Category
Buy-In (QMB)
Effective 4/1
COBRA
Continuation
Coverage
Effective 4/1
Year
Qualified
Disabled &
Working
Individual
Household Size
Resource Level
Special Notes
2005 COLA 2.7% inflation rate 2.6% estimate 01/01/05
2006 COLA 4.1% actual FPLs
2007 FPL’s are based on a COLA of 3.3%
1
2
2005
2006
2007
2008
2008
2009
2005
100% FPL
100% FPL
100% FPL
100%FPL
100% FPL
100% FPL
100% FPL
$798
$817
$851
$867
$867
$903
$798
$1,070
$1,100
$1,141
$1,167
$1,167
$1,215
$1,070
$4,000
$6,000
$4,000
$6,000
$4,000
$6,000
$4,000
$6,000
No Resource Test
No Resource Test
$4,000
$6,000
Medicare Part A & B, coinsurance, deductible and premium will be paid if eligible
Same as 2005
Same as 2005
Same as 2005
Same as 2005
Same as 2005
A/R may or may not be eligible for Medicaid benefits
2006
2007
2008
2008
$817
$851
$867
$867
$1,100
$1,141
$1,167
$1,167
$4,000
$6,000
$4,000
$6,000
$4,000
$6,000
No Resource Test
Same as 2005
Same as 2005
Same as 2005
Same as 2005
$1,040
$1,400
$4,000
A/R may be eligible for Medicaid to pay the COBRA continuation
2005
100% FPL
100%FPL
100%FPL
Greater than
100% but less
than 120%
Greater than
100% but less
than 120%
185% FPL
2006
2007
2008
2009
2005
2006
2007
2008
2009
2009
AIDS Health
Insurance
Program (AHIP)
Income
Compared
PAGE 554
1
2
$903
$1,215
$1,083
$1,457
$1,476
$1,978
No Resource Test
185% FPL
185% FPL
185% FPL
185% FPL
200% FPL
$1,511
$1,575
$1,604
$1,670
$1,595
$2,035
$2,111
$2,159
$2,247
$2,139
No Resource Test
No Resource Test
No Resource Test
No Resource Test
$4,000
$6,000
Same as 2005
Same as 2005
Same as 2005
A/R must be ineligible for Medicaid, including COBRA continuation
Medicaid will pay Medicare Part A premium
200% FPL
200% FPL
200% FPL
200%FPL
$1,634
$1,702
$1,734
$1,805
$2,200
$2,282
$2,334
$2,429
$4,000
$4,000
$4,000
$4,000
Same as 2005
Same as 2005
Same as 2005
Same as 2005
MRG
$6,000
$6,000
$6,000
$6,000
$6,000
A/R must be ineligible for Medicaid, including COBRA continuation. Premium
payments are FNP.
UPDATED: NOVEMBER 2009
Category
Specified Low Income
Medicare Beneficiaries
(SLIMBs)
Year
2005
2006
2007
2008
Effective 4/1
2008
2009
Qualified Individuals
(QI-1)
2005
2006
2007
2008
2009
Family Health Plus
Parents Living with
Children
Singles/Childless
Couples
2005
2006
2007
2008
2009
Income
Compared
Greater than 100%
but less than 120%
Greater than 100%
but less than 120%
Greater than 100%
but less than 120%
Greater than 100%
but less than 120%
Greater than 100%
but less than 120%
Greater than 100%
but less than 120%
Equal to or greater
than 120% but less
than 135%
Equal to or greater
than 120% but less
than 135%
Equal to or greater
than 120% but less
than 135%
Equal to or greater
than 120% but less
than 135%
Equal to or greater
than 120% but less
than 135%
150% FPL
100% FPL
150% FPL
100% FPL
150% FPL
100% FPL
150% FPL
100% FPL
150% FPL
100% FPL
PAGE 554.1
Household Size
Resource Level
Special Notes
2005 COLA 2.7% inflation rate 2.6% estimate 01/01/05
2006 COLA 4.1% actual FPLs
2007 FPL’s are based on a COLA of 3.3%
1
2
1
2
$798
$957
$817
$980
$851
$1,021
$867
$1,040
$867
$1,040
$903
$1,083
$957
$1,070
$1,283
$1,100
$1,320
$1,141
$1,369
$1,167
$1,400
$1,167
$1,400
$1,215
$1,457
$1,283
$4,000
$6,000
If the A/R is determined eligible, Medicaid will pay Medicare Part B
premium
$4,000
$4,000
$6,000
$6,000
Same as 2005
Same as 2005
$4,000
$6,000
Same as 2005
$1,077
No Resource Test
Same as 2005
No Resource Test
Same as 2005
$1,444
No Resource Test
If the A/R is determined eligible, Medicaid will pay Medicare Part B
premium
$980
$1,103
$1,320
$1,485
No Resource Test
$1,021
$1,149
$1,369
$1,541
No Resource Test
$1,040
$1,170
$1,400
$1,575
No Resource Test
$1,083
$1,219
$1,457
$1,640
$1,197
$1,604
Same as 2005
Same as 2005
Same as 2005
No Resource Test
$12,000
$798
$1,070
$1,225
$817
$1,277
$851
$1,300
$867
$1,354
$903
$1,650
$1,100
$1,712
$1,141
$1,750
$1,167
$1,822
$1,215
$17,550
Same as 2005
The A/R must be ineligible for Medicaid. The A/R cannot spenddown to
become eligible for Family Health Plus.
Same as 2005
$12,450
$16,200
$12,600
$16,200
Same as 2005
Same as 2005
$13,050
$13,800
MRG
$19,200
$20,100
Same as 2005
UPDATED: NOVEMBER 2009
Category
Family Planning Benefit
Program (FPBP)
Medicaid Buy-in
Program for People with
Disabilities (MBI-WPD)
Effective 4/1
Year
Medicaid Cancer
Treatment Programs
Household Size
Resource Level
Special Notes
2005 COLA 2.7% inflation rate 2.6% estimate 01/01/05
2006 COLA 4.1% actual FPLs
2007 FPL’s are based on a COLA of 3.3%
1
2
2005
200% FPL
$1,595
$2,139
No Resource Test
2006
2007
2008
2009
200% FPL
200% FPL
200% FPL
200% FPL
$1,634
$1,702
$1,734
$1,805
$2,200
$2,282
$2,334
$2,429
No Resource Test
No Resource Test
No Resource Test
No Resource Test
2007
250% FPL
$2,128
$2,853
$10,000
2008
2008
250% FPL
250% FPL
250% FPL
$2,167
$2,167
$2,257
$2,917
$2,917
$3,036
$10,000
$13,050
$19,200
$13,800
$20,100
2005
2006
2007
2008
250% FPL
250% FPL
250% FPL
250% FPL
$1,994
$2,042
$2,128
$2,167
$2,673
$2,750
$2,853
$2,917
No Resource Test
No Resource Test
No Resource Test
No Resource Test
2009
250% FPL
$2,257
$3,036
No Resource Test
2009
Breast and Cervical
Cancer
Income
Compared
PAGE 554.2
1
MRG
2
The A/R must be ineligible for Medicaid or Family Health Plus. The A/R
cannot spenddown to become eligible for Family Planning Benefit
Program.
Same as 2005
Same as 2005
Same as 2005
Provides Medicaid coverage for family planning services to persons of
childbearing age with incomes at or below 200% FPL. Potentially eligible
individuals will be screened for Medicaid and FHPlus, unless they
specifically request to be screened only for FPBP eligibility.
A/R’s with a net income that is at least 150% but at or below 250% will
pay a premium. Currently there is a moratorium on premium payment
collection.
Same as 2007
Same as 2007
Same as 2007
Includes both Breast and Cervical Cancer and Colorectal and Prostate
Cancer Treatment Programs
Same as 2008