Income Levels 510-03-85-40
(Revised 6/1/2021 ML #3622)
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IM 5455
(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 $1,482 $17,774 2 2,004 24,040 3 2,526 30,305 4 3,048 36,570 5 3,570 42,835 6 4,092 49,100 7 4,614 55,366 8 5,136 61,631 9 5,658 67,896 10 6,181 74,161 Plus - 1 $523 $6,265 Effective April 1, 2021
- Children ages 0 through 6 - 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 $1,632 $19,578 2 2,207 26,478 3 2,782 33,379 4 3,357 40,280 5 3,932 47,181 6 4,507 54,082 7 5,082 60,982 8 5,657 67,883 9 6,232 74,784 10 6,808 81,685 +1 $576 $6,901 Effective April 1, 2021
- ACA Adults age 19 and 20 and 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 $966 $11,592 2 1,307 15,678 3 1,647 19,764 4 1,988 23,850 5 2,328 27,936 6 2,669 32,022 7 3,009 36,108 8 3,350 40,194 9 3,690 44,280 10 4,031 48,366 +1 $341 $4,086 Effective April 1, 2021
- 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 $988 $11,850 2 1,336 16,026 3 1,684 20,203 4 2,032 24,380 5 2,380 28,557 6 2,728 32,734 7 3,076 36,910 8 3,424 41,087 9 3,772 45,264 10 4,121 49,441 +1 $349 $4,177 Effective April 1, 2021
- 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 $999 $11,978 2 1,351 16,201 3 1,702 20,423 4 2,054 24,645 5 2,406 28,867 6 2,758 33,089 7 3,110 37,312 8 3,462 41,534 9 3,813 45,756 10 4,165 49,978 +1 $352 $4,222 Effective April 1, 2021
- Pregnant Women - 157% + 5% Disregard or 162%
The family size is increased for each unborn when determining the appropriate family size.
|
Household Size |
Monthly Income Level |
Yearly Income Level |
| 1 |
$1,739 |
$20,866 |
| 2 | 2,352 | 28,220 |
| 3 | 2,965 | 35,575 |
| 4 | 3,578 | 42,930 |
| 5 | 4,191 | 50,285 |
| 6 | 4,804 | 57,640 |
| 7 | 5,417 | 64,994 |
| 8 | 6,030 | 72,349 |
| 9 | 6,642 | 79,704 |
| 10 | 7,255 | 87,059 |
| +1 | $613 | $7,355 |
| Effective April 1, 2021 | ||
- Optional Targeted Low-Income Children (CHIP) - 170% + 5% Disregard or 175%.
The family size is increased for each unborn when determining the appropriate family size.
|
Household Size |
Monthly Income Level |
Yearly Income Level |
| 1 | $1,879 | $22,540 |
| 2 | 2,541 | 30,485 |
| 3 | 3,203 | 38,430 |
| 4 | 3,865 | 46,375 |
| 5 | 4,527 | 54,320 |
| 6 | 5,189 | 62,265 |
| 7 | 5,851 | 70,210 |
| 8 | 6,513 | 78,155 |
| 9 | 7,175 | 86,100 |
| 10 | 7,838 | 94,045 |
| +1 | $663 | 7,945 |
| Effective April 1, 2021 | ||
- 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 $1,192
$14,297 $1,428 $17,130 2 1,612 19,336 1,931 23,169 3 2,032 24,376 2,434 29,207 4 2,452 29,415 2,938 35,245 5 2,872 34,454 3,441 41,283 6 3,292 39,494 3,944 47,321 7 3,712 44,533 4,447 53,360 8 4,132 49,573 4,950 59,398 9 4,551 54,612 5,453 65,436 10 4,971 59,651 5,957 71,474 +1 $420 $5,039 $504 $6,038 Effective April 1, 2021
