Appendix A: Determining Medical Assistance Eligibility and Payment Toward the Cost of LTC Facility Services

Income Limits
NMP-SSI Related Monthly Special Gross Income Limit - Effective 1/1/2013(300% of Federal Benefit Rate)		$2,130.00
MNO 6-Month Limit - 1 Person		$2,550.00
SSI Monthly 1 Person Limit - Effective 1/1/2013		$732.10
Deductions
	FSA
Dependent Child Maintenance Limit (No CS)	Schedule 1	$215.00
	Schedule 2	$205.00
	Schedule 3	$195.00
	Schedule 4	$174.00
Disabled/Blind Child Maintenance Limit (SSI Limit) (No CS) - Effective 1/1/2013		$732.10
Low Income Subsidy Benchmark-Effective 1/1/2013		$36.57

Deductions
Personal Needs Allowance Deduction (No therapeutic activity earnings) -Effective 7/1/2007	$45.00
Shelter Cost -Effective 10/01/2012:
Heating Standard	$536.00
Non-heating Standard	$278.00
Homeless Standard	$143.00
Limited SUA (Effective October 1, 2012)	$54.00
Phone only	$33.00

Minimum Monthly Maintenance Needs Allowance (MinMMNA) -Effective 7/1/2012	$1,892.00
Minimum Monthly Maintenance Needs Allowance (MinMMNA) -Effective 7/1/2013	$1,939.00
Maximum Monthly Maintenance Needs Allowance (MaxMMNA) -Effective 1/1/2013	$2,898.00
Excess Monthly Shelter Standard -Effective 7/1/2012	$568.00
Excess Monthly Shelter Standard -Effective 7/1/2013	$582.00
Dependent Living with Community Spouse Allowance -Effective 7/1/2012	$1,892.00
Dependent Living with Community Spouse Allowance -Effective 7/1/2013	$1,939.00

Updated June 18, 2013 Replacing January 1, 2013