UPDATED: JUNE 2010
INCOME/RESOURCE TEST
PAGE 537
Category
Year
Income
Compared
1
2
Presumptive
Eligibility for
Pregnant Women
2006
100% FPL
200% FPL
N/A
N/A
$1,100
$2,200
No Resource Test
Qualified provider makes the presumptive eligibility determination Cannot
spenddown to become presumptive eligible
2007
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
$1,141
$2,282
$1,167
$2,334
$1,215
$2,429
$1,215
$2,429
No Resource Test
Same as 2006
No Resource Test
Same as 2006
No Resource Test
Same as 2006
No Resource Test
2006
100% FPL
200% FPL
N/A
N/A
$1,100
$2,200
No Resource Test
2007
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
$1,634
$1,141
$2,282
$1,167
$2,334
$1,215
$2,429
$1,215
$2,429
$2,200
No Resource Test
No Resource Test
Same as 2006
No Resource Test
Same as 2006
No Resource Test
Same as 2006
2006
100% FPL
200% FPL
100% FPL
200% FPL
100% FPL
200% FPL
100% FPL
200% FPL
200% FPL
An Article 28 Pre-Natal Care provider or other entity designated by SDOH who has
completed required training makes the PE determination. Cannot spenddown to
become eligible for presumptive eligibility.
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 2006
No Resource Test
2007
2008
2009
2010
2006
200% FPL
200% FPL
200% FPL
200% FPL
133% FPL
$1,702
$1,734
$1,805
$1,805
$1,087
$2,282
$2,334
$2,429
$2,429
$1,463
No Resource Test
No Resource Test
No Resource Test
No Resource Test
No Resource Test
2007
2008
2009
2010
2006
133% FPL
133% FPL
133% FPL
133% FPL
100% FPL
$1,132
$1,153
$1,201
$1,201
$817
$1,518
$1,552
$1,615
$1,615
$1,100
No Resource Test
No Resource Test
No Resource Test
No Resource Test
No Resource Test
2007
2008
2009
2010
100% FPL
100% FPL
100% FPL
100% FPL
$851
$867
$903
$903
$1,141
$1,167
$1,215
$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 2006
Same as 2006
Same as 2006
Same as 2006
If the income is above 133% FPL the A/R must spenddown to the Medicaid income
level, resources will also be evaluated
Same as 2006
Same as 2006
Same as 2006
If the income is above 133% FPL the A/R must spenddown to MA income level
If the income is above 100% FPL the A/R must spenddown to the Medicaid income
level, resources will also be evaluated
Same as 2006
Same as 2006
Same as 2006
If the income is above 100% FPL the A/R must spenddown to MA income level,
2008
2009
2010
Pregnant Women
2008
2009
2010
Children Under
One
Children Age 1
through 5
Children Age 6
through 18
Household Size
Resource Level
1
Special Notes
2
MRG
UPDATED: JUNE 2010
Category
Year
Income
Compared
Under 21, ADCrelated and FNP
2006
MA Level
2007
2008
2008
2009
2010
2006
MA Level
MA Level
MA Level
MA Level
MA Level
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
MA Standard
MA Standard
MA Standard
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
MA Standard
MA Standard
MA Standard
MA Level
MA Level
MA Level
MA Level
MA Level
MA Level
Effective 4/1
Singles/Childless
Couples
2007
2008
Effective 4/1
Low Income
Families
2008
2009
2010
2006
2007
2008
Effective 4/1
SSI-Related
Effective 4/1
2008
2009
2010
2006
2007
2008
2008
2009
2010
PAGE 538
Household Size
Resource Level
1
1
2
$692
$900
$700
$775
$725
$767
$767
Varies by
County
Varies by
County
Varies by
County
$673
$706
$707
Varies by
County
Varies by
County
Varies by
County
$673
$706
$707
$692
$700
$725
$725
$767
$767
$900
$1,067
$1,067
$1,117
$1,117
Varies by
County
Varies by
County
Varies by
County
$840
$881
$883
Varies by
County
Varies by
County
Varies by
county
$840
$881
$883
$900
$900
$1,067
$1,067
$1,117
$1,117
Special Notes
2
$4,150
$5,400
$4,200
$5,400
$4,250
$6,400
$13,050
$19,200
$13,800
$20,100
No Resource Test
$2,000
$2,000
FNP parents cannot spenddown
$2,000
$2,000
Same as 2006
Same as 2006
Same as 2006
Same as 2006
Same as 2006
The A/R cannot spenddown income or resources. Over age 60, resources
are $3000.
Same as 2006
$2,000
$2,000
Same as 2006
$13.050
$19,200
$13,800
$20,100
No Resource Test
$3,000
$3,000
The A/R cannot spenddown income or resources
Same as 2008
The A/R cannot spenddown income
The A/R cannot spenddown income or resources
$3,000
$3,000
Same as 2006
$3000
$3000
Same as 2006
$13,050
$19,200
$13,800
$20,100
No Resource Test
$4,150
$5,400
$4,200
$5,400
$4,350
$6,400
$13,050
$19,200
$13,800
$20,100
$13,800
$20,100
MRG
The A/R cannot spenddown income or resources.
The A/R cannot spenddown income
Household size is always one or two
Same as 2006
Same as 2006
Same as 2006
Same as 2006
Same as 2006
UPDATED: JUNE 2010
PAGE 539
Category
Year
Income
Compared
1
2
Buy-In (QMB)
2006
2007
2008
2008
2009
2010
2006
100% FPL
100% FPL
100%FPL
100% FPL
100% FPL
100% FPL
100% FPL
$817
$851
$867
$867
$903
$903
$817
$1,100
$1,141
$1,167
$1,167
$1,215
$1,215
$1,100
$4,000
$6,000
$4,000
$6,000
$4,000
$6,000
No Resource Test
No Resource Test
No Resource Test
$4,000
$6,000
2007
2008
2008
100%FPL
100%FPL
100% FPL
$851
$867
$867
$1,141
$1,167
$1,167
$4,000
$4,000
$4,000
$6,000
$6,000
$6,000
2009
2010
100% FPL
100% FPL
$903
$903
$1,215
$1,215
$4,000
$4,000
$6,000
$6,000
2006
185% FPL
$1,511
$2,035
No Resource Test
2007
2008
2009
2010
2006
185% FPL
185% FPL
185% FPL
185% FPL
200% FPL
$1,575
$1,604
$1,670
$1,670
$1,634
$2,111
$2,159
$2,247
$2,247
$2,200
No Resource Test
No Resource Test
No Resource Test
No Resource Test
$4,000
$6,000
Same as 2006
Same as 2006
A/R must be ineligible for Medicaid, including COBRA continuation
Same as 2009
Medicaid will pay Medicare Part A premium
2007
2008
2009
2010
200% FPL
200% FPL
200%FPL
200% FPL
$1,702
$1,734
$1,805
$1,805
$2,282
$2,334
$2,429
$2,429
$4,000
$6,000
$4,000
$6,000
$4,000
$6,000
No Resource Test
Same as 2006
Same as 2006
Same as 2006
Same as 2006
Effective 4/1
COBRA
Continuation
Coverage
Effective 4/1
AIDS Health
Insurance
Program (AHIP)
Qualified
Disabled &
Working
Individual
Household Size
Resource Level
1
Special Notes
2
MRG
Medicare Part A & B, coinsurance, deductible and premium will be paid if eligible
Same as 2006
Same as 2006
Same as 2006
Same as 2006
Same as 2006
A/R must be ineligible for Medicaid, including COBRA continuation. Premium
payments are FNP
UPDATED: JUNE 2010
Category
Specified Low Income
Medicare Beneficiaries
(SLIMBs)
Year
2006
2007
2008
Effective 4/1
2008
2009
2010
Qualified Individuals
(QI-1)
2006
2007
2008
2009
2010
Family Health Plus
Parents Living with
Children
Singles/Childless
Couples
2006
2007
2008
2009
2010
PAGE 539.1
Income
Compared
Household Size
Resource Level
Special Notes
1
2
1
2
Greater than 100%
but less than 120%
$817
$980
$1,100
$1,320
$4,000
$6,000
If the A/R is determined eligible, Medicaid will pay Medicare Part B
premium
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
$851
$1,021
$867
$1,040
$867
$1,040
$903
$1,083
$903
$1,083
$980
$1,103
$1,141
$1,369
$1,167
$1,400
$1,167
$1,400
$1,215
$1,457
$1,215
$1,457
$1,320
$1,485
$4,000
$6,000
Same as 2006
$4,000
$6,000
Same as 2006
$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
$1,083
$1,457
$1,129
$1,640
$1,225
$817
$1,650
$1,100
$1,277
$851
$1,300
$867
$1,354
$903
$1,354
$903
$1,712
$1,141
$1,750
$1,167
$1,822
$1,215
$1,822
$1,215
150% FPL
100% FPL
150% FPL
100% FPL
150% FPL
100% FPL
150% FPL
100% FPL
No Resource Test
Same as 2006
No Resource Test
Same as 2006
No Resource Test
Same as 2006
No Resource Test
If the A/R is determined eligible, Medicaid will pay Medicare Part B
premium
Same as 2006
Same as 2006
No Resource Test
Same as 2006
Same as 2006
No Resource Test
$12,450
$16,200
$12,600
$16,200
The A/R must be ineligible for Medicaid. The A/R cannot spenddown to
become eligible for Family Health Plus
Same as 2006
Same as 2006
$13,050
$13,800
$19,200
$20,100
Same as 2006
No Resource Test
Same as 2006
MRG
UPDATED: JUNE 2010
PAGE 539.2
Category
Year
Income
Compared
1
2
Family Planning Benefit
Program (FPBP)
2006
200% FPL
$1,634
$2,200
No Resource Test
2007
2008
2009
200% FPL
200% FPL
200% FPL
$1,702
$1,734
$1,805
$2,282
$2,334
$2,429
No Resource Test
No Resource Test
No Resource Test
2010
2007
200% FPL
250% FPL
$1,805
$2,128
$2,429
$2,853
No Resource Test
$10,000
2008
2008
250% FPL
250% FPL
2009
250% FPL
2010
250% FPL
$2,167
$2,167
$2,257
$2,257
$2,917
$2,917
$3,036
$3,036
$10,000
$13,050
$19,200
$13,800
$20,100
$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
2010
250% FPL
250% FPL
$2,257
$2,257
$3,036
$3,036
No Resource Test
No Resource Test
Medicaid Buy-in
Program for People with
Disabilities (MBI-WPD)
Effective 4/1
Breast and Cervical
Cancer
Medicaid Cancer
Treatment Programs
Household Size
Resource Level
1
MRG
Special Notes
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 2006
Same as 2006
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.
Same as 2009
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
Same as 2007
See Medicaid Cancer Treatment Programs after 2007
Includes both Breast and Cervical Cancer and Colorectal and Prostate
Cancer Treatment Programs
Same as 2008
Same as 2008