Am I Eligible?

Category

Income Compared to:  

Household Size 

 Resource Level

 Special Notes

 1

 2

 1

2

 Presumptive Eligibility for Pregnant Women

 100% FPL

 N/A

$1100

 No Resource Test

Qualified provider makes the presumptive eligibility determination. Cannot spend down to become eligible for presumptive eligibility.

 185% FPL

 N/A

 $2035

 Pregnant Women and Infants under the Age of One

 100% FPL

 N/A

$1100

 No Resource Test

If the woman is determined eligible in any month of her pregnancy, she is guaranteed eligibility for the entire pregnancy (prospectively). If the A/R applies prior to the birth of the child, she is entitled to a 60-day post-partum extension also. The baby will have guaranteed eligibility for one year if the baby resides with the mother. If the income is above 200% FPL, the A/R must spend down to the MA income level.

 200% FPL

 N/A

$2200

All Children under  Age 19

100% Federal Poverty Level

 $818

$1100

No Resource Test

Effective 1/1/99, all children under the age of 19 must have their eligibility determined at the 100% FPL, except children age 1-6 which still need eligibility determined at the 133% level. Use code "D" or "B" in the EEC field. Children are guaranteed 12 months of continuous coverage every time eligibility is determined or re-determined using this method, or LIF.

 Children Ages 1 –6

 133% Federal Poverty Level

 $1087

$1,463

  No Resource Test

 Under 21 and/or ADC-Related

 Medicaid Level

 $692

$900

 $4,150

$5,400

 SNF(HR)-Related

PA Standard of Need

 $371*

$480.50**

 $2000 under age 60

$3000 over age 60

SNF(HR)-Related Parents

PA Standard

$371*

$480.50**

$2000 under age 60

A HR budget must be done first. The Applicant/Recipient can not spend down income or resources.

$3000 over age 60

SSI-Related

Medicaid Level

$692

$900

$4,150

$5,400

Household size is always one or two.

Buy-In (QMB)

100% FPL

$817

$1100

$4,000

$6,000

Medicare Part A & B, coinsurance, deductible and premium will be paid if eligible.

COBRA Continuation Coverage

100%FPL

$817

$1100

$4,000

$6,000

A/R may or may not be eligible for MA benefits. Premium payments are always FP, except when payments are expedited.

AIDS Insurance

185% FPL

$1,511

$2,035

No Resource Test

A/R must be ineligible for MA, including COBRA continuation. Premium payments are FNP.

Specified Low Income Medicare Beneficiaries (SLIMBs)

Between
100% FPL

$817

$1100

$4,000

$6,000

If the A/R is determined eligible, MA will pay Medicare Part B premium.

120% FPL

$980

$1,320

Qualified Working and Disabled Individuals

200% FPL

$1,634

$2,200

$4,000

$6,000

MA will pay Medicare Part A premium

Qualified Individuals (QI-1'S)

120% FPL

$980

$1,320

No Resource Test

MA will pay Medicare Part B Premium.

135% FPL

$1,103

$1,485

Qualified Individuals (QI-2'S)

135% FPL

$1,103

$1,485

No Resource Test

MA will reimburse a portion of the Medicare Part B Premium.

175% FPL

 $1,511

$2,035

Family Health Plus (FHP) Parents Living with Children

150%

$1225

$1650

$12,450

$16,200

The A/R must be ineligible for Medical Assistance.  The A/R cannot spend down to become eligible.

(FHP) Singles/Childless Couples

150%

$1225

$1650

$12,450

$16,200

Family Planning Benefit Program

200%

$1634

$2200

No Resource Test

The A/R must be ineligible for Medical Assistance of Family Health Plus.  The A/R cannot spend down to become eligible.