Income Levels 510-03-85-40
(New 7/1/2014 ML #3404)
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IM 5238
IM 5238 Attachment
IM 5236
IM 5236 Attachment A
IM 5236 Attachment B
IM 5221
IM 5221 Attachment A
IM 5221 Attachment B
IM 5221 Attachment C
IM 5221 Attachment D
(N.D.A.C. Sections 75-02-02.1-40, 75-02-02.1-22(7), 75-02-02.1-24.2(8), and 75-02-02.1-24(5))
Following are the Income Levels for the various categories under ACA Medicaid Categorically Needy:
- Parents and Caretakers of Deprived Children and their Spouses – ACA Equivalent to 1931 Levels.
The family size is increased for each unborn when determining the appropriate family size.
Number of Persons Monthly Income Level 1
$517
2 694 3 871 4 1048 5 1226 6 1403 7 1580 8 1757 9 1934 10 2111 Plus - 1 178 Effective April 1, 2014
- Children ages 6 through 18 and Individuals eligible for the Adult Expansion Group - 133% + the 5% disregard or 138%.
The family size is increased for each unborn when determining the appropriate family size.
Household Size Monthly Income Level Annual Income Level 1 $1342 $16105 2 1809 21,707 3 2276 27,310 4 2743 32,913 5 3210 38,516 6 3677 44,119 7 4143 49,721 8 4610 55,324 9 5077 60,927 10 5544 66,530 Plus - 1 467 5,603 Effective April 1, 2014
- Children ages 0 through 5 and Pregnant Women - 147% + the 5% disregard or 152%.
The family size is increased for each unborn when determining the appropriate family size.
Household Size Monthly Income Level Annual Income Level 1 $1478 $17,738 2 1992 23,910 3 2507 30,081 4 3201 36,252 5 3535 42,423 6 4050 48,594 7 4564 54,766 8 5078 60,937 9 5592 67,108 10 6107 73,279 +1 514 6,171 Effective April 1, 2014
- ACA Medically Needy(Pregnant Women and Children ONLY) – 83% of Poverty Level.
The family size is increased for each unborn when determining the appropriate family size.
Household Size Monthly Income Level 1 $807 2 1,088 3 1,369 4 1,650 5 1,930 6 2,211 7 2,492 8 2,773 9 3,054 10 3,335 +1 281 Effective April 1, 2014
- ACA Maintenance of Effort – Medicaid – Children ages 6 through 18.
The family size is increased for each unborn when determining the appropriate family size.
Household
Size
111% FPL
Monthly
111% FPL
Annual
133% FPL
Monthly
133% FPL
Annual
1 $1,079
$12,954 $1,293 $15,521 2 $1,455 $17,460 $1,743 $20,921 3 $1,831 $21,967 $2,193 $26,321 4 $2,206 $26,474 $2,643 $31,721 5 $2,582 $30,980 $3,093 $37,120 6 $2,957 $35,487 $3,543 $42,520 7 $3,333 $39,993 $3,993 $47,920 8 $3,708 $44,500 $4,443 $53,320 9 $4,084 $49,007 $4,893 $58,720 10 $4,459 $53,513 $5,343
$64,119 +1 $376 $4,507 $450 $5,400 Effective April 1, 2014
