Income Levels 510-05-85-40

(Revised 4/1/04 ML #2912)

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(N.D.A.C. Sections 75-02-02.1-40, 75-02-02.1-22(7), and 75-02-02.1-24(5))

 

Levels of income for maintenance must be used as a basis for establishing financial eligibility for Medicaid. The Medicaid income levels represent the amount of income reserved to meet the maintenance needs of an individual or family. The income levels applicable to individuals and units are:

 

1. Categorically needy income levels.

1. Family Coverage group. The family size is increased for each unborn when determining the appropriate family size.

Number of Persons	Monthly Income Level
1	$311
2	417
3	523
4	629
5	735
6	841
7	947
8	1053
9	1159
10	1265
Effective April 1, 2004

 

For each person in the unit above ten, add $107.

2. Categorically needy aged, blind, and disabled recipients. Except for individuals subject to the nursing care income level, the income level which establishes SSI eligibility.

2. Medically needy income levels.

1. Medically needy income levels are applied when a Medicaid individual or unit resides in their own home or in a specialized facility, and when a Medicaid individual has been screened as requiring nursing care, but elects to receive HCBS. The family size is increased for each unborn when determining the appropriate family size.

Number of Persons	Monthly Income Level
1	$500
2	516
3	666
4	800
5	908
6	1008
7	1083
8	1141
9	1200
10	1250
Effective January 1, 2003

For each person in the Medically needy unit above ten, add fifty-seven dollars to the monthly amount.

2. Nursing care income level. The nursing care income level is fifty dollars per month and must be applied to residents receiving nursing care services in nursing facilities, intermediate care facilities for the mentally retarded (ICF-MR), the state hospital, the Prairie Psychiatric Center, the Stadter Psychiatric Center, the Anne Carlsen facility, or receiving swing bed care in a hospital.
3. Community spouse income level. The income level for a community spouse who is eligible for Medicaid is subject to the categorically needy, medically needy, or poverty level income levels. The level for an ineligible community spouse is $2267, or a higher amount if ordered by a court or hearing officer.
4.  Family member income level. The income level for each ineligible family member in a spousal impoverishment case is $521 effective April 2004 ($505 effective April 2003).

3. Poverty income levels.

1. Qualified Medicare Beneficiaries and Children age six to nineteen. The income level is equal to one hundred percent of the poverty level applicable to a family of the size involved.

For Qualified Medicare Beneficiaries these levels apply regardless of living arrangements (i.e., in home or in a nursing facility...).

 

Annual Title II cost of living allowances effective in January shall be disregarded when determining eligibility for QMBs for January, February, and March. This disregard prevents QMBs from becoming ineligible pending issuance of the new poverty levels which are effective April 1 of each year.

 

For individuals and families with children age six to nineteen, the family size is increased for each unborn when determining the appropriate family size.

 

Number of Persons	Monthly Income Level
1	$ 776
2	1041
3	1306
4	1571
5	1836
6	2101
7	2366
8	2631
9	2896
10	3161
Effective April 1, 2004

 

For each person in the Medicaid unit above ten, add $266 to the monthly amount.

2. Specified Low-Income Medicare Beneficiaries. The income level is equal to one hundred twenty percent of the poverty level applicable to a family of the size involved. This is the maximum income level for SLMBs. Applicants or recipients who have income at or below one hundred percent of the poverty level are not eligible as a SLMB, but must be a QMB. These income levels apply regardless of living arrangements (i.e., in home or in a nursing facility. . . ).

 

Annual Title II cost of living allowances effective in January shall be disregarded when determining eligibility for SLMBs for January, February, and March. This disregard prevents SLMBs from becoming ineligible pending issuance of the new poverty levels which are effective April 1 of each year.

 

Number of Persons	Monthly Income Levels
1	$ 932
2	1250
3	1568
4	1886
5	2204
6	2522
7	2840
8	3158
9	3476
10	3794
Effective April 1, 2004

For each person in the Medicaid unit above ten, add $319 to the monthly amount.

3. Pregnant women and children under age six. The income level is equal to one hundred and thirty-three percent of the poverty level, applicable to a family of the size involved. The family size is increased for each unborn when determining the appropriate family size.

Number of Persons	Monthly Income Level
1	$1032
2	1385
3	1737
4	2090
5	2442
6	2795
7	3147
8	3500
9	3852
10	4204
Effective April 1, 2004

 

For each person in the Medicaid unit above ten, add $353 to the monthly amount.

4. Qualifying Individuals. The income level is equal to 135% of the poverty level applicable to a family of the size involved. This is the maximum income level for QIs. Applicants or recipients who have income at or below 120% of the poverty level are not eligible as a QI, but may be eligible as a SLMB or QMB. These income levels apply regardless of living arrangements (i.e., in home or in a nursing facility...).

 

Annual Title II cost of living allowances effective in January shall be disregarded when determining eligibility for QIs for January, February, and March. This disregard prevents QIs from becoming ineligible pending issuance of the new poverty levels, which are effective April 1 of each year.

 

Number of Persons	Monthly Income Level
1	$ 1048
2	1406
3	1763
4	2121
5	2479
6	2837
7	3194
8	3552
9	3910
10	4268
Effective April 1, 2004

 

For each person in the Medicaid unit above ten, add $358 to the monthly amount.

5. Transitional Medicaid Benefits. The income level is equal to one hundred and eighty-five percent of the poverty level applicable to a family of the size involved.

Number of Persons	Monthly Income Level
1	$1436
2	1926
3	2416
4	2907
5	3397
6	3887
7	4377
8	4868
9	5358
10	5848
Effective April 1, 2004

For each person in the Medicaid unit above ten, add $491 to the monthly amount.