INCOME LEVELS EFFECTIVE *APRIL 1, 2009

Caring for
Children
Children
&
Age Pregnant
Children
6 to 19 Women Workers
with with
and & Healthy Transition Disabiliti
Steps al Disabilities
Famil Family Medicall SSI QMB SLMB Child to QI-1 es
y Coverag y Medicaid &
Age 6
e
Size Needy Women’s
(1931) Way
120% 135%
(Effective of of
01/01/09) 150% of
100% of 133% of 225% of
Povert Povert 200% of
Poverty 185% of Poverty
Poverty y Poverty y
Poverty
Poverty

1 $311 $ 500 $674 $ 903 $1083 $1201 $1219 $1354 $1670 $1805 $2031
2 417 516 1011 1215 1457 1615 1640 1822 2247 2429 2732
3 523 666 1526 1831 2030 2060 2289 2823 3052 3434
4 629 800 1838 2205 2444 2481 2757 3400 3675 4135
5 735 908 2150 2579 2859 2902 3224 3976 4299 4836
6 841 1008 2461 2953 3273 3323 3692 4553 4922 5537
7 947 1083 2773 3327 3688 3743 4159 5130 5545 6239
8 1053 1141 3085 3701 4102 4164 4627 5706 6169 6940
9 1159 1200 3396 4075 4517 4585 5094 6283 6792 7641
10 1265 1250 3708 4449 4931 5006 5562 6859 7415 8342
+1* 107 57 312 374 415 421 468 577 624 702

Spousal Impoverishment Levels

P:\Healthy Steps\Medicaid Income Level Chart – Effective 04-01-2009.doc

 INCOME LEVELS EFFECTIVE *APRIL 1, 2009
Community Spouse Community Spouse Community Spouse Income Level for
Minimum Asset Maximum Asset Income Level each Additional
Allowance Allowance Individual
(Effective 01/01/03)
(Effective 01/01/09) (Effective 01/01/09) (Effective 04/01/09)

$21,912 $109,560 $2,267 $607

Average Cost of Nursing Care

Average Monthly Average Daily

Cost of Care Cost of Care

(Effective 01/01/09) (Effective 01/01/09)

$5453 $179.27

Note: LTC income level increased from $40 to $50 effective with the benefit month of 01/01/02

*Caring for Children eligibility guidelines changed from 141-170% FPL to 151-200% FPL as of 11/01/08

(Due to Healthy Steps eligibility guidelines change to 150% as of 10/01/08)

Rev 02/2009

P:\Healthy Steps\Medicaid Income Level Chart – Effective 04-01-2009.doc