Im 5062 Attached Chart 2009 Medicaid Income Level Chart - Effective 04-01-09

INCOME LEVELS EFFECTIVE *APRIL 1, 2009 Caring for Children

Children Age

Pregnant

6 to 19

Women

and Famil y Size

Family Coverag e

Medicall y

SSI

QMB

& Children

& SLMB

Child to

QI-1

Healthy Steps

Age 6

Transition al

Disabilities

Medicaid

&

Needy

(1931) (Effective 01/01/09)

120% of 100% of Poverty

Povert y

135% of 133% of Poverty

Povert y

$311 417 523 629 735 841 947 1053 1159 1265 107

$ 500 516 666 800 908 1008 1083 1141 1200 1250 57

$674 1011

$ 903 1215 1526 1838 2150 2461 2773 3085 3396 3708 312

$1083 1457 1831 2205 2579 2953 3327 3701 4075 4449 374

Spousal Impoverishment Levels P:\Healthy Steps\Medicaid Income Level Chart – Effective 04-01-2009.doc

$1201 1615 2030 2444 2859 3273 3688 4102 4517 4931 415

$1219 1640 2060 2481 2902 3323 3743 4164 4585 5006 421

Workers with Disabiliti es

Women’s Way 150% of Poverty

185% of Poverty

1 2 3 4 5 6 7 8 9 10 +1*

with

$1354 1822 2289 2757 3224 3692 4159 4627 5094 5562 468

$1670 2247 2823 3400 3976 4553 5130 5706 6283 6859 577

200% of

225% of Poverty

Poverty

$1805 2429 3052 3675 4299 4922 5545 6169 6792 7415 624

$2031 2732 3434 4135 4836 5537 6239 6940 7641 8342 702

INCOME LEVELS EFFECTIVE *APRIL 1, 2009 Community Spouse Minimum Asset Allowance

Community Spouse Maximum Asset Allowance

(Effective 01/01/09)

(Effective 01/01/09)

$21,912

$109,560

Community Spouse Income Level (Effective 01/01/03)

Income Level for each Additional Individual (Effective 04/01/09)

$2,267

$607

Average Cost of Nursing Care Average Monthly

Average Daily

Cost of Care

Cost of Care

(Effective 01/01/09)

(Effective 01/01/09)

$5453

$179.27

Note: LTC income level increased from $40 to $50 effective with the benefit month of 01/01/02 *Caring for Children eligibility guidelines changed from 141-170% FPL to 151-200% FPL as of 11/01/08 (Due to Healthy Steps eligibility guidelines change to 150% as of 10/01/08)

Rev 02/2009

P:\Healthy Steps\Medicaid Income Level Chart – Effective 04-01-2009.doc