Healthy Connections (Medicaid) Program Income Charts
The Healthy Connections (Medicaid) program provides coverage under many different eligibility categories
with varying income requirements. More than one income table may be applicable if more
than one eligibility category appears to be appropriate.
General Hospital,
Nursing Home, TEFRA/Katie Beckett and
Home and Community Based (Waiver) Services
(300% of the Federal Benefit Rate-FBR)
January 1, 2009
| Family Size
|
Monthly Income Limit
|
| Individual
|
$2,022
|
| Spousal Allocation
|
$2,739
|
Optional State Supplementation (OSS)
January 1, 2009
| Monthly Net Income Limit:
|
| $1,157
|
Aged, Blind or Disabled
100% Of Poverty Level
March 1, 2009
| Family Size
|
Monthly Income
|
Annual Income
|
| 1
|
$903
|
$10,830
|
| 2
|
$1,215
|
$14,570
|
Optional Coverage For Pregnant Women And Infants
185% of Poverty Level
March 1, 2009
| Family Size
|
Monthly Income
|
Annual Income
|
| 1
|
$1,670
|
$20,036
|
| 2
|
$2,247 |
$26,955
|
| 3
|
$2,823
|
$33,874 |
| 4
|
$3,400
|
$40,793
|
| 5
|
$3,976
|
$47,712
|
| 6
|
$4,553
|
$54,631
|
| 7
|
$5,130
|
$61,550
|
| 8
|
$5,706
|
$68,469
|
| Each Additional Member
|
$577
|
$6,919
|
For each additional family member, add $6,919 to the annual income.
Divide by 12 and round up to the next whole dollar for the monthly income.
Healthy Connections Plans for Children Under Age 19
COVERAGE FOR CHILDREN AGE 1 TO 19
March 1, 2009
100%, 133%, 150%, 185%, and 200% of the Federal Poverty Level
| Family Size
| 100% FPL
| 133% FPL
| 150% FPL
| 185% FPL
| 200% FPL
|
| 1
|
$903
|
$1,201
|
$1,354
|
$1,670
|
$1,805
|
| 2
|
$1,215
|
$1,615
|
$1,822
|
$2,247
|
$2,429
|
| 3
|
$1,526
|
$2,030
|
$2,289
|
$2,823
|
$3,052
|
| 4
|
$1,838
|
$2,444
|
$2,757
|
$3,400
|
$3,675
|
| 5
|
$2,150
|
$2,859
|
$3,224
|
$3,976
|
$4,299
|
| 6
|
$2,461
|
$3,273
|
$3,692
|
$4,553
|
$4,992
|
| 7
|
$2,773
|
$3,688
|
$4,159
|
$5,130
|
$5,545
|
| 8
|
$3,085
|
$4,102
|
$4,627
|
$5,706
|
$6,169
|
| Each additional person
|
$312
|
$415
|
$468
|
$577
|
$624
|
For each additional family member add the amount shown to the monthly income.
Gap Assistance Pharmacy Program For Seniors (GAPS)
GAPS is not a Medicaid program.
It is a state-funded program administered by the Department of Health and Human Services.
200% Of Poverty Level
February 24, 2009
| Family Size
| Monthly Income
| Annual Income
|
| 1
|
$1,805
|
$21,660
|
| 2
|
$2,429
|
$29,140
|
| 3
|
$3,052
|
$36,620
|
| 4
|
$3,675
|
$44,100
|
| 5
|
$4,299
|
$51,580
|
| 6
|
$4,922
|
$59,060
|
| 7
|
$5,545
|
$66,540
|
| 8
|
$6,169
|
$74,020
|
| Each additional member
|
$624
|
$7,480
|
For each additional family member, add $7,480 to the annual income. Divide by 12 and round up to the next whole dollar for the monthly income.
Specified Low Income Medicare Beneficiaries (SLMB)
March 1, 2009
120% of Poverty Level
| Family Size
|
SLMB
120%
|
QI
135%
|
| 1 (Individual)
|
$1,083
|
$1,219
|
| 2 (Couple)
|
$1,457
|
$1,640
|
| Family Size
|
Monthly Income
|
Annual Income
|
| 1
|
$2,257
|
$27,075 |
| 2
|
$3,036
|
$36,425
|
| 3
|
$3,815
|
$45,775
|
| 4
|
$4,594
|
$55,125
|
| 5
|
$5,373
|
$64,475
|
| 6
|
$6,153
|
$73,825
|
| 7
|
$6,932
|
$83,175
|
| 8
|
$7,711
|
$92,525
|
| Each Additional Member
|
$780
|
$9,350
|
For each additional family member, add $9,350 to the annual income.
Divide by 12 and round up to the next whole dollar for the monthly income.
Low Income Families (LIF)
November 1, 2009
| Family Size
| Gross Income Limit
| Net Income Limit
|
| 1
|
$835
|
$452
|
| 2
|
$1,124
|
$608
|
| 3
|
$1,412
|
$764
|
| 4
|
$1,700
|
$920
|
| 5
|
$1,988
|
$1,076
|
| 6
|
$2,277
|
$1,231
|
| 7
|
$2,565
|
$1,387
|
| 8
|
$2,853
|
$1,543
|
Note: For family sizes over 8, add $156.00 for each extra person to the net income limit for 8. To calculate the gross income limit, multiply the net income limit by 185%.
REGULAR FOSTER CARE MEDICAID INCOME LIMITS
November 1, 2009
| Family Size
|
Monthly Income Limit
|
| 1
|
$452
|
| 2
|
$608
|
| 3
|
$764
|
| 4
|
$920
|
| 5
|
$1,076
|
| 6
|
$1,231
|
| 7
|
$1,387
|
| 8
|
$1,543
|
Note: For family sizes over 8, add $156.00 for each extra person to the monthly income limit.
Breast and Cervical Cancer Program (BCCP) (200% of the Federal Poverty Level) March 1, 2009
| Family Size
|
Monthly Income
|
Annual Income
|
| 1
|
$1,805
|
$21,660
|
| 2
|
2,429
|
29,140
|
| 3
|
3,052
|
36,620
|
| 4
|
3,675
|
44,100
|
| 5
|
4,299
|
51,580
|
| 6
|
4,922
|
59,060
|
| 7
|
5,545
|
66,540
|
| 8
|
6,169
|
74,020
|
| Each Additional Member
|
624
|
7,480
|
For each additional family member, add $7,480 to the annual income. Divide by 12 and round up to the next whole dollar for the monthly income.
Family Planning (FP) Waiver Services
185% of Poverty Level
March 1, 2009
| Family Size
|
Monthly Income
|
Annual Income
|
| 1
|
$1,670
|
$20,036 |
| 2
|
$2,247 |
$26,955
|
| 3
|
$2,823
|
$33,874 |
| 4
|
$3,400 |
$40,793
|
| 5
|
$3,976
|
$47,712 |
| 6
|
$4,553
|
$54,631 |
| 7
|
$5,130 |
$61,550 |
| 8
|
$5,706
|
$68,469 |
| Each Additional Member
|
$577
|
$6,919 |
For each additional family member, add $6,919 to the annual income.
Divide by 12 and round up to the next whole dollar for the monthly income.
|
