Appendix J: Eligibility Standards for MHABD

Program	Monthly income limit ($)	Effective date	Asset maximum ($)	Effective date
Spend Down (includes disabled child) – MHNS, MHSD, MHDC
1 person – aged or disabled	913	04-01-21	5,035	07-01-21
2 people – aged or disabled	1,234	04-01-21	10,070	07-01-21
1 person – blind	1,074	04-01-21	5,035	07-01-21
2 people – blind	1,452	04-01-21	10,070	07-01-21
SGA (Substantial Gainful Activity) – aged or disabled	1,310	01-01-21
SGA – blind	2,190	01-01-21
SSI (Supplemental Security Income)
1 person in own household	794	01-01-21
2 people in own household	1,191	01-01-21
1 person in another’s household	529	01-01-21
2 people in another’s household	794	01-01-21
SSI essential person in own household	397	01-01-21
SSI 1619 (a) and (b)	3,693	01-01-21	2,000 individual 3,000 couple
Qualified Medicare Beneficiary (QMB)
1 person	1,074	04-01-21	7,970	01-01-21
2 people	1,452	04-01-21	11,960	01-01-21
3 People	1,830	04-01-21	11,960	01-01-21
Specified Low-Income Medicare Beneficiary 1 (SLMB or SLMB1)
1 person	1,288	04-01-21	7,970	01-01-21
2 people	1,742	04-01-21	11,960	01-01-21
3 people	2,196	04-01-21	11,960	01-01-21
Specified Low-Income Medicare Beneficiary 2 (SLMB2 or QI-1)
1 person	1,449	04-01-21	7,970	01-01-21
2 people	1,960	04-01-21	11,960	01-01-21
3 people	2,471	04-01-21	11,960	01-01-21
Blind Pension (BP)	7,259 (sighted spouse)	04-01-21	29,999	2018
Supplemental Aid to the Blind (SAB) consolidated standard	857	01-01-21	5,035 individual 10,070 couple	07-01-21
Qualified Disabled and Working Individuals (QDWI)
1 person	2,147	04-01-21	4,000
2 people	2,903	04-01-21	6,000
Ticket to Work Health Assurance (TWHA)
1 person	3,220	04-01-21	5,035	07-01-21
2 people	4,355	04-01-21	10,070	07-01-21

TWHA premium amounts – effective date 04-01-2019
Percent of FPL	Single or couple	Monthly income ($)	Monthly premium ($)
Less than or equal to 100%	Single	1,074 or less	0
	Couple	1,452 or less	0
101% to 149%	Single	1,074.01 – 1,609.99	42
	Couple	1,452.01 – 2,177.99	56
150% to 199%	Single	1,610 – 2,146.99	62
	Couple	2,178 – 2,903.99	85
200% to 249%	Single	2,147 – 2,683.99	104
	Couple	2,904 – 3,629.99	141
250% to 300%	Single	2,684 – 3,220	156
	Couple	3,630 – 4,355	211

Other expenses	Amount ($)	Effective Date
Supplementary Medical Insurance (SMI) – Medicare Part B monthly premium	148.50	01-01-21
State mileage rate (per mile)	0.49	07-01-21

Vendor Care – in a nursing facility, institution for the intellectually disabled, or mental or psychiatric hospital
Vendor Surplus Calculation		Asset Maximum ($)	Effective Date
All income paid to the facility as surplus minus $50 personal needs allowance and allowable deductions: medical insurance premiums, allotments, child support		5,035 after Division of Assets	07-01-21
Home and Community Based Services (HCB) – nursing facility care in your own home
Monthly income limit ($) for eligible individual (not including spouse)	Effective date	Asset Maximum ($)	Effective Date
1,388	01-01-21	5,035 after Division of Assets	07-01-21
Other numbers used for Vendor and HCB calculations
Spousal share – used to determine Division of Assets		Available assets ($)	Effective Date
Minimum		26,076	01-01-21
Maximum		130,380	01-01-21
Allotment of income – used to determine allotments to a community spouse or dependents		Monthly amount ($)	Effective Date
Minimum monthly maintenance needs allowance (MMMNA)		2,178	07-01-21
Maximum MMMNA		3,260	01-01-21
Maximum allocation to a child		397	01-01-21
Shelter Expenses – used to determine allotments to a community spouse
Allowable Expense		Monthly limit ($)	Effective Date
Shelter standard		653	07-01-21
Utility standard		415	10-01-21
Telephone standard		67	10-01-21
Maximum home equity – For Vendor, HCB, or PACE		Asset Maximum ($)	Effective Date
		603,000	01-01-21
Transfer of property penalty
Average monthly private pay nursing rate		6,588	04-01-21

Supplemental Nursing Care (SNC) – cash grant to participants living in supported living facilities
SNC income eligibility determination	Asset Maximum	Effective Date
SNC grant is available if the facility’s monthly residential care expense exceeds the participant’s countable income. The grant amount is the deficit up to the maximum monthly grant amount.	5,035 individual 10,070 couple	07-01-21
Grant type	Maximum monthly grant amount ($)	Effective Date
Residential care facility I	156	07-01-00
Residential care facility II Assisted living facility Intermediate or skilled without a level of care determination	292	07-01-00
Intermediate or skilled with a level of care determination	390	07-01-00
Personal needs allowance paid to all SNC participants	50	01-01-15

Updated 10/2021