Income Levels 510-05-85-40

(Revised 10/1/13 ML #3390)

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IM 5200

 

 

(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))

 

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. This is for households who applied and were found eligible for benefits starting prior to January 1, 2014.

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.

 

Effective for benefits starting January 1, 2014, this group will be the “Parents, Caretaker Relative,s and their Spouses” group. The income level changes for them as follows:

Number of Persons	Monthly Income Level
1	$ 517
2	698
3	879
4	1060
5	1241
6	1422
7	1602
8	1783
9	1964
10	2145
Plus - 1	181
Effective January 1, 2014

 

3. Effective for benefits starting January 1, 2014, the Adult Expansion group and the Children’s group are Categorically Needy Groups. Children ages 6 through 18 and individuals eligible for the Expansion group are covered up to one hundred thirty-three percent of the federal poverty level. They are allowed a disregard of 5% of the federal poverty level. The following table includes this information.

 

Number of Persons	Monthly Income Level   133%	Monthly Income Level Plus 5% Disregard   138%
1	1274	1322
2	1720	1784
3	2165	2246
4	2611	2709
5	3056	3171
6	3502	3633
7	3947	4096
8	4393	4558
9	4838	5020
10	5284	5483
Plus - 1	446	463
Effective January 1, 2014

 

4. Effective for benefits starting January 1, 2014, the Pregnant Women group and the Children’s group are Categorically Needy Groups. Children ages 0 through 5 and Pregnant Women are covered up to one hundred forty-seven percent of the federal poverty level. They are allowed a disregard of 5% of the federal poverty level. The following table includes this information.

 

Number of Persons	Monthly Income Level     147%	Monthly Income Level Plus 5% Disregard   152%
1	1408	1456
2	1900	1964
3	2392	2474
4	2885	2983
5	3377	3492
6	3870	4001
7	4362	4511
8	4855	5020
9	5347	5529
10	5840	6038
Plus - 1	492	509
Effective January 1, 2014

 

 

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 income level is equal to eighty-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	$795
2	1073
3	1351
4	1629
5	1907
6	2185
7	2464
8	2742
9	3020
10	3298
Effective April 1, 2013

For each person in the medically needy unit above ten, add $279 to the monthly amount.

2. Nursing care income level. The nursing care income level is sixty-five dollars per month and must be applied to residents receiving psychiatric or nursing care services in nursing facilities, the state hospital, the Prairie at Saint John's Center, the Stadter Center, a Psychiatric Residential Treatment Facility (PRTF), or receiving swing bed care in a hospital.
3. ICF-ID income level. The income level for a resident of an Intermediate Care Facility for the intellectually disabled (ICF-ID), including the Anne Carlsen facility, is $100 effective October 1, 2010.
4. 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.
5.  Family member income level. The income level for each ineligible family member in a spousal impoverishment case is $646 effective July 2013 ($630 effective July 2012).

3. Poverty income levels.

1. Qualified Medicare Beneficiaries and Children age six to nineteen. Effective with new applicants and reviews for benefits starting January 1, 2014, children will not be covered under this income level. Those approved whose benefits started prior to January 2014 are subject to this income level until their next review. 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	$   958
2	1293
3	1628
4	1963
5	2298
6	2633
7	2968
8	3303
9	3638
10	3973
Effective April 1, 2013

For each person in the Medicaid unit above ten, add $335 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 Level
1	$ 1149
2	1551
3	1953
4	2355
5	2757
6	3159
7	3561
8	3963
9	4365
10	4767
Effective April 1, 2013

For each person in the Medicaid unit above ten, add $402 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. Effective with new applicants and reviews for benefits starting January 1, 2014, pregnant women and children under age 6 will not be covered under this income level. They are also no longer considered to be in the poverty level group. Those approved whose benefits started prior to January 2014 are subject to this income level until their next review.

Number of Persons	Monthly Income Level
1	$  1274
2	1720
3	2165
4	2611
5	3056
6	3502
7	3947
8	4393
9	4838
10	5284
Effective April 1, 2013

For each person in the Medicaid unit above ten, add $446 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	$ 1293
2	1745
3	2198
4	2650
5	3102
6	3554
7	4007
8	4459
9	4911
10	5363
Effective April 1, 2013

For each person in the Medicaid unit above ten, add $453 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	$1772
2	2392
3	3011
4	3631
5	4251
6	4871
7	5490
8	6110
9	6730
10	7350
Effective April 1, 2013

For each person in the Medicaid unit above ten, add $620 to the monthly amount.

6. Workers with Disabilities.  The income level is equal to two hundred and twenty-five percent of the poverty level applicable to a family of the size involved.

Number of Persons	Monthly Income Level
1	$ 2155
2	2909
3	3662
4	4416
5	5170
6	5924
7	6677
8	7431
9	8185
10	8939
Effective April 1, 2013

For each person in the Medicaid unit above ten, add $754 to the monthly amount.

7. Children with Disabilities. The income level is equal to two hundred percent of the poverty level applicable to a family of the size involved.

Number of Persons	Monthly Income Level
1	$ 1915
2	2585
3	3255
4	3925
5	4595
6	5265
7	5935
8	6605
9	7275
10	7945
Effective April 1, 2013

For each person in the Medicaid unit above ten, add $670 to the monthly amount.