ATTACHMENT VI
MA POVERTY LINES FOR CHILD HEALTH PLUS 1997-2004
Medicaid-Only, (Annual and Monthly) Income and Resource Standards
and Federal Poverty Lines Effective January 1, 1997
Household Size
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
100% FPL
Children born after
9/30/83, ages 6-18
133% FPL
Children ages 1-5
185%
Infants up to age 1
7890
658
10610
885
13330
1111
16050
1338
18770
1565
21490
1791
24210
2018
26930
2245
EACH
ADDITIONAL
PERSON
+2720
+ 227
10494
875
14597
1217
14112
1176
19629
1636
17729
1478
24661
2056
21347
1779
29693
2475
24965
2081
34725
2894
28582
2382
39757
3314
32200
2684
44789
3733
35817
2985
49821
4152
+3618
+ 302
+5032
+ 420
Medicaid-Only, (Annual and Monthly) Income and Resource Standards
and Federal Poverty Lines Effective January 1, 1998
Household Size
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
100% FPL
Children born after
9/30/83, ages 6-18
133% FPL
Children ages 1-5
185%
Infants up to age 1
8150
680
10950
913
13750
1146
16550
1380
19350
1613
22150
1846
24950
2080
27750
2313
EACH
ADDITIONAL
PERSON
+2800
+ 234
10840
904
15078
1257
14564
1214
20258
1689
18288
1524
25438
2120
22012
1835
30618
2552
25736
2145
35798
2984
29460
2455
40978
3415
33184
2766
46158
3847
36908
3076
51338
4279
+3724
+ 311
+5180
+ 432
Medicaid-Only, (Annual and Monthly) Income and Resource Standards
and Federal Poverty Lines Effective June 1, 1998
Household Size
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
100% FPL
Children born after
9/30/83, ages 6-18
133% FPL
Children ages 1-5
185%
Infants up to age 1
8050
671
10850
905
13650
1138
16450
1371
19250
1605
22050
1838
24850
2071
27650
2305
EACH
ADDITIONAL
PERSON
+2800
+ 234
10707
893
14983
1242
14431
1203
20073
1673
18155
1513
25253
2105
21879
1824
30433
2537
25603
2134
35613
2968
29327
2444
40793
3400
33051
2755
45973
3832
36775
3065
51153
4263
+3724
+ 311
+5180
+ 432
1
MA POVERTY LINES FOR CHILD HEALTH PLUS 1997-2004
Medicaid-Only, (Annual and Monthly) Income and Resource Standards
and Federal Poverty Lines Effective January 1, 1999
Household Size
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
100% FPL
Children born after
9/30/83, ages 6-18
133% FPL
Children ages 1-5
8240
687
11060
922
13880
1157
16700
1392
19520
1627
22340
1862
25160
2097
27980
2332
EACH
ADDITIONAL
PERSON
+2820
+ 235
10960
914
14710
1226
18461
1539
22211
1851
25962
2164
29713
2477
33463
2789
37214
3102
+3750
+ 312
185%
Infants up to age 1
15244
1271
20461
1706
25678
2140
30895
2575
36112
3010
41329
3445
46546
3879
51763
4314
+5217
+ 435
Medicaid-Only, (Annual and Monthly) Income and Resource Standards
and Federal Poverty Lines Effective January 1, 2000
Household Size
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
100% FPL
Children born after
9/30/83, ages 6-18
133% FPL
Children ages 1-5
8350
696
11250
938
14150
1180
17050
1421
19950
1663
22850
1905
25750
2146
28650
2388
EACH
ADDITIONAL
PERSON
+2820
+ 242
11106
926
14963
1247
18820
1569
22677
1890
26534
2212
30391
2533
34248
2854
38105
3176
+3857
+ 322
185%
Infants up to age
15448
1288
20813
1735
26178
2182
31543
2629
36908
3076
42273
3523
47638
3970
53003
4417
+5365
+ 448
200%
Infants up to age 1
effective 11/1/00
16700
1392
22500
1875
Medicaid-Only, (Annual and Monthly) Income and Resource Standards
and Federal Poverty Lines Effective January 1, 2001
Household Size
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
100% FPL
Children ages 6-18
133% FPL
Children ages 1-5
8590
716
11425
953
11610
968
15442
1287
14630
1220
19458
1622
17650
1471
23475
1957
20670
1723
27492
2291
23690
1975
31508
2626
26710
2226
35525
2961
29730
2478
39541
3296
EACH
ADDITIONAL
PERSON
+3020
+ 252
+4017
+ 335
200%
Infants up to age 1
17180
1432
23220
1935
29260
2439
35300
2942
41340
3445
47380
3949
53420
4452
59460
4955
+6040
+ 504
2
MA POVERTY LINES FOR CHILD HEALTH PLUS 1997-2004
Medicaid-Only, (Annual and Monthly) Income and Resource Standards
and Federal Poverty Lines Effective January 1, 2002
Household Size
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
100% FPL
Children ages 6-18
1/1/02-3/31/02
133% FPL
Children ages 1-5 and
children ages 6-18,
beginning 4/1/02
200%
Infants up to age 1
8860
739
11940
995
15020
1252
18100
1509
21180
1765
24260
2022
27340
2279
30420
2535
EACH
ADDITIONAL
PERSON
+3080
+ 257
11784
982
15881
1324
19977
1665
24073
2007
28170
2348
32266
2689
36363
3031
40459
3372
+4097
+ 342
17720
1477
23880
1990
30040
2504
36200
3017
42360
3530
48520
4044
54680
4557
60840
5070
+6160
+ 514
Medicaid-Only, (Annual and Monthly) Income and Resource Standards
and Federal Poverty Lines Effective January 1, 2003
Household Size
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
133% FPL
Children ages 1-18
11944
996
16120
1344
20296
1692
24472
2040
28649
2388
32825
2736
37001
3084
41177
3432
EACH
ADDITIONAL
PERSON
+4177
+ 349
200%
Infants up to age 1
17960
1497
24240
2020
30520
2544
36800
3067
43080
3590
49360
4114
55640
4637
61920
5160
+6280
+ 524
Medicaid-Only, (Annual and Monthly) Income and Resource Standards
and Federal Poverty Lines Effective January 1, 2004
Household Size
ONE
TWO
THREE
FOUR
FIVE
SIX
SEVEN
EIGHT
133% FPL
Children ages 1-18
200%
Infants up to age 1
12383
1032
18620
1552
16612
1385
24980
2082
20842
1737
31340
2612
25071
2090
37700
3142
29300
2442
44060
3672
33530
2795
50420
4202
37759
3147
56780
4732
41989
3500
63140
5262
EACH
ADDITIONAL
PERSON
+4230
+ 353
+6360
+ 530
3