Eligibility Online Manual

Medicaid Table 1 - Federal Poverty Level (FPL) Standards

Effective Date: April 1, 2022


****5% disregard chart, if it will make a difference in eligibility deduct amount from applicants total gross income for MAGI programs.

Column A

Number of assistance unit members being considered in the computation.

Column B

Maximum income standard for Family Care benefits.

Column C

Standard of income used to determine if Qualified Medicare Beneficiary (QMB) is eligible for assistance. Use the appropriate assistance unit size, but DO NOT exceed an assistance unit size of two.

Column D

Standard for Specified Low-Income Medicare Beneficiary (SLMB) #1, whose income is from 101% to 120%, DO NOT exceed an assistance unit size of two.

Column E

Standard of income used to determine if a Poverty Level for a child age 6-18 is eligible for assistance.

Column F

Standard for Qualified Individuals (QI) whose income is from 121% to 135% FPL, DO NOT exceed an assistance unit size of two.

Column G

Standard of income used to determine if a Poverty Level Pregnant Woman or a child through the age of 5 is eligible for

Column H

Standard used to determine if a woman is eligible for Pregnant By Choice.

Column I

Standard used to determine the second six months of continuing medical eligibility for families who have lost Family Care benefits due to an increase in earned income.

Column J

Standard used to determine eligibility for Kid Care CHIP.

Column K

Standard used to determine eligibility for the Breast and Cervical Cancer Treatment Program.