Family and Children's Medicaid MA-3305 MAF, MIC, HSF BUDGETING

VII. INCOME table (effective 04/01/12)

A. MIC Income Limits

1. MIC-N Child Age 6 through 18 - 100% of Poverty Income Level

Number in Needs Unit	Income Level Eff. 04-01-12
1	$ 931
2	1,261
3	1,591
4	1,921
5	2,251
6	2,581
7	2,911
8	3,241
For each additional member, add $330

2. MIC-N Child Age 1 through 5 - 133% of Poverty Income Level

Number in Needs Unit	Income Level Eff. 04-01-12
1	$1,239
2	1,677
3	2,116
4	2,555
5	2,994
6	3,433
7	3,872
8	4,311
For each additional member, add $439

3. MIC-1 Child Age 1 through 5 – over 133% through 200% of Poverty Income Level

Number in Needs Unit	Income Level Eff. 04-01-12
1	1,239.01 – 1,862
2	1,677.01 – 2,522
3	2,116.01 – 3,182
4	2,555.01 – 3,842
5	2,994.01 – 4,502
6	3,433.01 – 5,162
7	3,872.01 – 5,822
8	4,311.01 – 6,482
For each additional member, add $439 -- $660

REVISED 04/01/12 – CHANGE NO. 05-12

4. MIC-N Child Under age one and MAF-D Family Planning - 185% of Poverty Income Level

Number in Needs Unit	Income Level Eff. 04-01-12
1	$1,723
2	2,333
3	2,944
4	3,554
5	4,165
6	4,775
7	5,386
8	5,996
For each additional member, add $611

5. MIC-1 Child Under age one – between 185% and 200% of Poverty Income Level

Number in Needs Unit	Income Level Eff. 04-01-12
1	$1723.01 – 1,862
2	2,333.01 – 2,522
3	2,944.01 – 3,182
4	3,554.01 – 3,842
5	4,165.01 – 4,502
6	4,775.01 – 5,162
7	5,386.01 – 5,822
8	5,996.01 – 6,482
For each additional member, add $611 - $660

6. 12 Month Transitional Medicaid Income Limits – 185% of Poverty Income Level

Number in Needs Unit	Income Level Eff. 04-01-12
1	$1,723
2	2,333
3	2,944
4	3,554
5	4,165
6	4,775
7	5,386
8	5,996
For each additional member, add $611

REISSUED 04/01/12 – CHANGE NO. 05-12

B. M-AF & H-SF Income Limits

1. Categorically Needy (N)

Number in Needs Unit	Income Level Eff. 01-01-90
1	$ 362
2	472
3	544
4	594
5	648
6	698
7	746
8	772
9	812
10	860
11	896
12	946
13	992
14	1,042
For each additional member, add $50

2. Medically Needy (MN)

Number in Needs Unit	Income Level Eff. 01-01-90
1	$242
2	317
3	367
4	400
5	433
6	467
7	500
8	525
9	542
10	575
11	600
12	633
13	667
14	700
For each additional member, add $33