Ch. 4 - How To Make Managed Care Work :: Advocate's Guide to Managed Health Care

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PCAP and Medicaid Monthly Income Levels

Child Health Plus Premium Levels

Regular Medicaid Levels

FHP Income Resource Levels

Last Updated: October 2008

INCOME AND RESOURCES MEDICAID, FAMILY HEALTH PLUS & CHILD HEALTH PLUS A/B

Each program - Medicaid (MA), Family Health Plus (FHP) and Child Health Plus (CHP) A and B has different income and resource eligibility requirements.

The income and resource charts below will give a client a basic idea of which program his/she is eligible for. It is advised that clients look at the specific chapter for the program that they believe they are eligible for to obtain more detailed information. For each program, there are certain disallowances that may modify the income that the client has.

The following charts will help clients determine which program they are eligible for based on INCOME and RESOURCES. These numbers are based on the annual Federal Poverty Limits (FPL) and change each year.

WHAT COUNTS AS INCOME?

There are two types of income that one needs to consider when determining a client's eligibility for Medicaid, Family Health Plus, or Child Health Plus: earned and un-earned.

Earned income is any money earned from work (salary, wages, tips, commission or bonuses)
Unearned income is money received through means other than working: pension, government benefits, unemployment, rent from a boarder, alimony, etc.

When calculating income, most individuals can get an idea of what they are eligible for based on their gross income- how much money a person have/get each month. This chapter will not go into detailed budgeting around what counts and does not count as income. For this type of detailed budgeting, please refer the Medicaid Reference Guide which details all aspects of income and can be accessed here.

PCAP and Medicaid Monthly Income Levels (Pregnant Women and Children Under 19)
Clients who are between the ages of 19 and 64, the disabled and person 65 and over must meet the regular Medicaid income and resource levels as outlined in this chart:

FAMILY SIZE	1	2	3	4	5	6	Each Add'l Person, Add:
Children under 1yr: Pregnant Women Perinatal Coverage Only (200% FPL)	$1,734	$2,334	$2,934	$3,534	$,4134	$4,734	$600
Children 1-5 (133% FPL)	$,1153	$1,552	$1,951	$,2350	$2,749	$3,148	$399
Children 6-18 (100% FPL)	$867	$1,167	$1,467	$1,767	$2,067	$2,367	$300
Children 19-20 yrs: Parents/Disabled Individuals	$725	$1,067	$1,234	$1,392	$,1550	$1,709	$159
Pregnant Women (count as 2 people) Full Coverage (100% FPL)		$1,167	$1,467	$1,767	$2,067	$2,367	$300

Child Health Plus Premium Levels -- Monthly Income by Family Size (Children Under 19 NOT Medicaid-Eligible)

FAMILY SIZE	1	2	3	4	5	6	Each Add'l Person, Add:
Free Insurance (160% FPL)	$1,386	$,1866	$,2345	$2,826	$3,306	$3,786	$480
$9 per child per month (Max. $27 per family) (222% FPL)	$,1924	$2,590	$3,256	$3,922	$4,588	$5,254	$666
$15 per child per month (Max. $45 per family) (250% FPL)	$2,167	$2,917	$3,667	$4,417	$5,167	$5,917	$750
$20 per child per month (Max. $60 per family) (300% FPL)	$2,600	$3,500	$4,400	$5,300	$6,200	$7,100	$900
$30 per child per month (Max. $90 per family) (350% FPL)	$3,034	$4,084	$5,134	$6,184	$7,234	$8,284	$1,050
$40 per child per month (Max. $120 per family) (400% FPL)	$3,467	$4,667	$5,867	$7,067	$8,267	$9,467	$1,200

Regular Medicaid Levels (Parents, 19 and 20 year olds, 24-64 disabled or blind, 65 and over)

FAMILY SIZE	1	2	3	4	5	6
Monthly Income	$725	$1,067	$1,231	$1,392	$1,550	$1,709
Resource Level	$13,050	$1,9200	$22,200	$25,050	$27,900	$30,750

FAMILY SIZE (cont.)	7	8	9	10	Each Add'l Person, Add:
Monthly Income	$1,867	$2,034	$2,192	$2,350	$159
Resource Level	$33,600	$36,600	$39,450	$42,300	$2,850

FHP Income Resource Levels (Parents living with children under 21 in their household; 19-20 year olds living with their parents)

FAMILY SIZE	1	2	3	4	5	6
FHP Limit 150% FPL	$,1300	$1,750	$2,200	$2,650	$3,100	$3,550
Resource Level	$13,050	$1,900	$22,200	$25,050	$27,900	$30,750

FAMILY SIZE (cont.)	7	8	9	10	Each Add'l Person, Add:
FHP Limit 150% FPL	$4,000	$4,450	$4,900	$,5350	$450
Resource Level	$33,600	$36,600	$39,450	$42,300	$2,850

FHP Income Resource Levels (Adults without children under 21 in household, and 19-20 year olds living alone)

	Family of 1	Family of 2
Income Levels (100% FPI)	$867	$,1167
Resource Levels	$13,050	$19,200

A NOTE ABOUT THE RESOURCE REQUIREMENT:

Resources are cash or other assets, which can be easily converted to cash, such as bank accounts, life insurance, stocks, bonds, or mutual fund shares.

Resources include property not readily converted to cash (i.e. real property)

Not all resources count. There are certain types of resources that do not count to toward the resource limit. For resource disallowances, please contact one of the resources listed at the end of this chapter.

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