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 01/01/2014

$2,163.00

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 01/01/2014

$743.10

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 01/01/2014

$743.10

Disabled/Blind Child Maintenance Limit (SSI Limit)

(No CS) - Effective 1/1/2013

$732.10

Low Income Subsidy Benchmark-Effective 01/01/2014

$35.50

Low Income Subsidy Benchmark-Effective 1/1/2013

$36.57   

Determining Payment toward the Cost of LTC Facility Services: Spousal Impoverishment Provisions

Deductions

Personal Needs Allowance Deduction
(No therapeutic activity earnings) -Effective 7/1/2007

$45.00

Shelter Cost -Effective 10/01/2013:

Heating Standard

$536.00

Non-heating Standard

$278.00

Homeless Standard

$143.00

Limited SUA (Effective October 1, 2013)

              $55.00

Phone only

$33.00

Minimum Monthly Maintenance Needs Allowance (MinMMNA) -Effective 7/1/2013

$1,939.00

Maximum Month;ly Maintenance Needs Allowance (MaxMMNA)-- Effective 01/01/2014

$2,931.00

Maximum Monthly Maintenance Needs Allowance (MaxMMNA) -Effective 1/1/2013

$2,898.00

Excess Monthly Shelter Standard -Effective 7/1/2013

$582.00

Dependent Living with Community Spouse Allowance -Effective 7/1/2013

$1,939.00

 

 

Maximum Protected Share (Effected 01/01/2014)

$117,240.00

Minimum Protected Share  (Effected 01/01/2014)

$23,448.00

Determining a Penalty Period (Effective 01/01/2014)

 

Average Monthly Private Pay Rate

$8,766.39

Average Daily Private Pay Rate

$288.21

Excess Home Equity Limit

$543,000.00

 

Updated January 29, 2014  Replacing November 26, 2013