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

NMP-SSI Related Monthly Special Gross Income Limit-- Effective 1/1/2015 (300% of Federal Benefit Rate)

$2,199.00

NMP-SSI Related Monthly Special Gross Income Limit - Effective 1/1/2014 (300% of Federal Benefit Rate)

$2,163.00

MNO 6-Month Limit - 1 Person

$2,550.00

SSI Monthly 1 Person Limit -- Effective 1/1/2015

$755.10

SSI Monthly 1 Person Limit - Effective 1/1/2014

$743.10

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 1/1/2015

$755.10

Disabled/Blind Child Maintenance Limit (SSI Limit)

(No CS) - Effective 1/1/2014

$743.10

Low Income Subsidy Benchmark-Effective 1/1/2015

$33.91

Low Income Subsidy Benchmark-Effective 1/1/204

$35.50   

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

$45.00

Shelter Cost -Effective 10/1/2014:

Heating Standard

$536.00

Non-heating Standard

$278.00

Homeless Standard

$143.00

Limited SUA (Effective 10/1, 2014)

 $55.00

Phone only

$33.00

Maximum Protected Share          Effective 1/1/2015

$119,220.00

Maximum Protected Share          Effective 1/1/2014

$117,240.00

Minimum Protected Share           Effective 1/1/2015

$23,844.00

Minimum Protected Share           Effective 1/1/2014

$23,448.00

Determining a Penalty Period      Effective 1/1/ 2015

Average Monthly Private Pay Rates

 $8,916.65

Average Daily Private Pay Rate

$293.15

Determining a Penalty Period                                                                   Effective 1/1/2014

Average Monthly Private Pay Rate

$$8766.39

Average Daily Private Pay Rate

$288.21

Excess Home Equity Limit                                   Effective  1/1/2015

$552,000.00

Excess Home Equity Limit                                  Effective  1/1/2014

$543,000.00