UPDATED: APRIL 2008
PAGE 552
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
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
$1,070
$2,139
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
$1,595
$1,100
$2,200
$1,141
$2,282
$1,167
$2,334
$2,139
No Resource Test
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
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
2005
200% FPL
200% FPL
200% FPL
133% FPL
$1,634
$1,702
$1,734
$1,061
$2,200
$2,282
$2,334
$1,422
No Resource Test
No Resource Test
No Resource Test
No Resource Test
2006
2007
2008
2005
133% FPL
133% FPL
133% FPL
100% FPL
$1,087
$1.132
$1,153
$798
$1,463
$1,518
$1,552
$1,070
No Resource Test
No Resource Test
No Resource Test
No Resource Test
2006
2007
2008
100% FPL
100% FPL
100% FPL
$817
$851
$867
$1,100
$1,141
$1,167
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
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
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
2005
2007
2008
Children Age 6
through 18
Special Notes
N/A
N/A
2006
Children Age 1
through 5
Resource Level
100% FPL
200% FPL
2008
Children Under
One
Household Size
2005
2007
Pregnant Women
Income
Compared
1
2
(MRG)
UPDATED: APRIL 2008
Category
Year
Income
Compared
PAGE 553
Household Size
2005
2006
2007
2008
Singles/Childless
Couples
2005
2006
2007
2008
Low Income
Families
2005
2006
2007
2008
SSI-Related
2005
2006
2007
2008
Buy-In (QMB)
2005
2006
2007
2008
Medicaid
Level
Medicaid
Level
Medicaid
Level
Medicaid
Level
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
PA Standard
of Need
Medicaid
Level
Medicaid
Level
Medicaid
Level
Medicaid
Levels
100% FPL
100% FPL
100% FPL
100%FPL
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
$900
$4,150
$5,400
Same as 2005
$700
$900
$4,200
$5,400
Same as 2005
$775
$1,067
$4,250
$6,400
Same as 2005
Varies by
County
Varies by
County
Varies by
County
Varies by
County
Varies by
County
Varies by
County
Varies by
County
Varies by
County
$667
Varies by
County
Varies by
County
Varies by
County
Varies by
County
Varies by
County
Varies by
County
Varies by
County
Varies by
county
$975
$2,000
$2,000
$2,000
$2,000
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
$3,000
$3,000
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
$4,000
$5,850
Household size is always one or two
$692
$900
$4,150
$5,400
Same as 2005
$700
$900
$4,200
$5,400
Same as 2005
$725
$1,067
$4,350
$6,400
Same as 2005
$798
$817
$851
$867
$1,070
$1,100
$1,141
$1,167
$4,000
$4,000
$4,000
$4,000
$6,000
$6000
$6,000
$6,000
Medicare Part A & B, coinsurance, deductible and premium will be paid if eligible
Same as 2005
Same as 2005
Same as 2005
(MRG)
UPDATED: APRIL 2008
Category
Cobra
Continuation
Coverage
AIDS Insurance
Qualified
Disabled &
Working
Individual
Specified Low
Income Medicare
Beneficiaries
(SLIMBs)
Year
Income
Compared
PAGE 554
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
$1,070
$4,000
$6,000
100% FPL
100%FPL
100%FPL
185% FPL
$817
$851
$867
$1,476
$1,100
$1,141
$1,167
$1,978
$4,000
$6,000
$4,000
$6,000
$4,000
$6,000
No Resource Test
2006
2007
2008
2005
185% FPL
185% FPL
185% FPL
200% FPL
$1,511
$1,575
$1,604
$1,595
$2,035
$2,111
$2,159
$2,139
No Resource Test
No Resource Test
No Resource Test
$4,000
$6,000
2006
2007
2008
200% FPL
200% FPL
200% FPL
Between
100% but less
than 120%
$1,634
$1,702
$1,734
$2,200
$2,282
$2,334
$4,000
$4,000
$4,000
$6,000
$6,000
$6,000
Same as 2005
Same as 2005
Same as 2005
$798
$957
$1,070
$1,283
$4,000
$6,000
If the A/R is determined eligible, Medicaid will pay Medicare Part B premium
Between
100% but less
than 120%
Between
100% but less
than 120%
Between
100% but less
than 120%
$817
$980
$1,100
$1,320
$4,000
$6,000
Same as 2005
$851
$1,021
$1,141
$1,369
$4000
$6,000
$867
$1,040
$1,167
$1,400
$4,000
$6,000
2005
100% FPL
2006
2007
2008
2005
2005
2006
2007
2008
A/R may or may not be eligible for Medicaid benefits
Same as 2005
Same as 2005
Same as 2005
A/R must be ineligible for Medicaid, including COBRA continuation. Premium
payments are FNP.
Same as 2005
Same as 2005
Same as 2005
Medicaid will pay Medicare Part A premium
Same as 2005
Same as 2005
(MRG)
UPDATED: APRIL 2008
Category
Qualified Individuals
(QI-1)
Year
2005
2006
2007
2008
Family Health Plus
Parents Living with
Children
Singles/Childless
Couples
2005
Cancer Treatment
Programs
150% FPL
100% FPL
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
$957
$1,283
$1,077
$1,444
$980
$1,103
$1,021
$1,149
$1,040
$1,170
$1,320
$1,485
$1,369
$1,541
$1,400
$1,575
$1,197
$1,604
1
2
No Resource Test
If the A/R is determined eligible, Medicaid will pay Medicare Part B
premium
Same as 2005
No Resource Test
Same as 2005
No Resource Test
Same as 2005
No Resource Test
$12,000
$17,550
2005
150% FPL
100% FPL
150% FPL
100% FPL
150% FPL
100% FPL
200% FPL
$1,225
$817
$1,277
$851
$1,300
867
$1,595
$1,650
$1,100
$1,712
$1,141
$1,750
$1,167
$2,139
$13,050
$19,200
No Resource Test
2006
2007
2008
2007
200% FPL
200% FPL
200% FPL
250% FPL
$1,634
$1,702
$1,734
$2,128
$2,200
$2,282
$2,334
$2,853
No Resource Test
No Resource Test
No Resource Test
$10,000
2008
250% FPL
$2,167
$2,917
$10,000
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
2008
Breast and Cervical
Cancer
Between 120% but
less than 135%
Between 120% but
less than 135%
Between 120% but
less than 135%
Between 120% but
less than 135%
Household Size
$1,070
2007
Medicaid Buy-in
Program for People with
Disabilities (MBI-WPD)
Income
Compared
$798
2006
Family Planning Benefit
Program
PAGE 554.1
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
(MRG)
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
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
Includes both Breast and Cervical Cancer and Colorectal and Prostate
Cancer Treatment Programs