Income Levels 510-03-85-40
(Revised 5/1/2017 ML #3498)
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IM 5345
IM 5345 Attachment
IM 5326
IM 5326 Attachment
(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 who are NOT eligible for Medicare, SSI or over age 65 – (ACA Equivalent to 1931 Levels).
The family size is increased for each unborn when determining the appropriate family size.
Household Size Monthly Income Level Yearly Income Level 1
$517
$6,204
2 694 8,328 3 871 10,452 4 1048 12,576 5 1226 14,712 6 1403 16,836 7 1580 18,960 8 1757 21,084 9 1934 23,208 10 2111 25,332 Plus - 1 178 2,136 Effective January 1, 2014
- Parents and Caretaker Relatives who ARE Medicare beneficiaries, SSI recipients or over age 65. (Parent and Caretaker Relative fixed dollar level listed in #1 above PLUS the 5% Federal Poverty Level disregard.)
The family size is increased for each unborn when determining the appropriate family size.
Household Size Monthly Income Level Annual Income 1 $566 $6,792 2 760 9,120 3 955 11,460 4 1,149 13,788 5 1,344 16,128 6 1,539 18,468 7 1,733 20,796 8 1,927 23,124 9 2,122 25,464 10 2,316 27,792 Plus - 1 195 2,339 Effective April 1, 2015
- 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 $1,386 $16,643 2 1,867 22,411 3 2,348 28,180 4 2,829 33,948 5 3,309 39,716 6 3,790 45,485 7 4,271 51,253 8 4,751 57,022 9 5,232 62,790 10 5,713 68,558 Plus - 1 480 5,768 Effective April 1, 2017
- Children ages 0 through 6 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 $1,527 $18,331 2 2,057 24,685 3 2,586 31,038 4 3,116 37,392 5 3,645 43,746 6 4,174 50,099 7 4,704 56,453 8 5,233 62,806 9 5,763 69,160 10 6,292 75,514 +1 529 6,354 Effective April 1, 2017
- ACA Medically Needy (Pregnant Women) – 90% of Poverty Level.
The family size is increased for each unborn when determining the appropriate family size.
Household Size Monthly Income Level Yearly Income Level 1 $904 $10,854 2 1,218 14,616 3 1,531
18,378 4 1,845 22,140 5 2,158 25,902 6 2,472 29,664 7 2,785 33,426 8 3,099 37,188 9 3,412 40,950 10 3,726 44,712 +1 313 3,762 Effective April 1, 2017
- ACA Medically Needy (Child 0 to 21) - 92% of Poverty Level.
The family size is increased for each unborn when determining the appropriate family size.
Household
Size
Monthly Income Level
Yearly Income
Level
1 $924
$11,095 2 1,245 14,941 3 1,565 18,786 4 1,886 22,632 5 2,206 26,478 6 2,526 30,323 7 2,847 34,169 8 3,167 38,014 9 3,488 41,860 10 3,808 45,706 +1 320 3,846 Effective April 1, 2017
- ACA Medically Needy (Parents/Caretaker relative and their spouses) - 93% of Poverty Level.
The family size is increased for each unborn when determining the appropriate family size.
Household
Size
Monthly Income Level
Yearly Income
Level
1 $934
$11,216 2 1,258 15,103 3 1,582 18,991 4 1,906 22,878 5 2,230 26,765 6 2,554 30,653 7 2,878 34,540 8 3,202 38,428 9 3,526 42,315 10 3,850 46,202 +1 323 3,887 Effective April 1, 2017
- 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 $1,115
$13,387 $1,336 $16,040 2 1,502 18,026 1,799 21,599 3 1,888 22,666 2,263 27,159 4 2,275 27,306 2,726 32,718 5 2,662 31,946 3,189 38,277 6 3,048 36,586 3,653 43,837 7 3,435 41,225 4,116 49,396 8 3,822 45,865 4,579 54,956 9 4,208 50,505 5,042 60,515 10 4,595 55,145 5,506
66,074 +1 386 4,640 463 5,559 Effective April 1, 2017
