Appendix XXXI, Budget Reference Chart

Revision 26-2; Effective June 1, 2026

Community-Based Programs Using SSI Limits (Disabled Adult Child, Pickle, Widow or Widowers)

Income — Effective Jan. 1, 2026, total countable income must be less than the Supplemental Security Income (SSI) federal benefit rate (FBR) with the exclusion of certain increases in Social Security benefits:

• Individual — $994
• Couple — $1,491
• Deeming amount — $497

Resources — Total countable resources must be no more than the limit:

• Individual — $2,000
• Couple — $3,000
• Companion — $3,000

In-Kind Support and Maintenance (Community Living Arrangement)

Effective Jan. 1, 2026:

• One-third of the SSI FBR:
  • Individual — $331.33
  • Couple — $497.00
• One-third of the SSI FBR + $20:
  • Individual — $351.33
  • Couple — $517.00
• One-half of the couple 1/3 SSI FBR:
  • Companion — $248.50
• One-half of the couple 1/3 SSI FBR + $10:
  • Companion — $258.50

All Living Arrangements

Effective Jan. 1, 2026, the special income exemption for a student’s earned income, regardless of living arrangement, is:

• Monthly earnings — $2,410
• Annual earnings — $9,730

Related Policy

Student Earnings, E-2220

Medicare Savings Programs (MSP)

Income limits are based on the federal poverty level (FPL).

Income — Effective March 1, 2026, total countable income must be:

• QMB — Not more than 100% FPL:
  • Individual — $1,330
  • Couple — $1,804
  • Deeming amount — $474
  • Medicaid benefits are:
    • Part A premiums
    • Part B premiums
    • Deductibles
    • Coinsurance
• SLMB — Greater than 100% FPL, but less than 120% FPL:
  • Individual — $1,330.01 to < $1,596
  • Couple — $1,804.01 to < $2,164
  • Deeming amount — $568
  • Medicaid benefits are:
    • Part B premiums
• QI-1 — At least 120% FPL, but less than 135% FPL:
  • Individual — $1,596 to < $1,796
  • Couple — $2,164 to < $2,435
  • Deeming amount — $639
  • Medicaid benefits are:
    • Part B premiums
• QDWI — No more than 200% FPL:
  • Individual — $ 2,660
  • Couple — $3,607
  • Deeming amount — $947
  • Medicaid benefits are:
    • Part A premiums

Note: These income limits do not include the $20 disregard for MSP.

Resources — Effective Jan. 1, 2026, total countable resources must be:

• QMB, SLMB, QI-1 — No more than the limit:
  • Individual — $9,950
  • Couple — $14,910
• QDWI — No more than twice the SSI resource limit:
  • Individual — $4,000
  • Couple — $6,000

Medicaid Buy-In (MBI) Program

Income — Effective March 1, 2026:

• Income eligibility is based on earnings.
• Countable earned income must be less than the limit:
  • 250% of FPL — $3,325

Resources — Total countable resources must be no more than the limit of $2,000.

MBI Monthly Premiums: Countable Unearned Income Minus (−) SSI FBR of $994 Plus (+) Earned Income Premium

Unearned Income Premium
Countable Unearned Income Minus (−) SSI FBR $994

Earned Income Premium

Countable Earned Income Based on FPL Range

If the unearned income premium amount plus the earned income premium amount equals or exceeds $500, then the total monthly premium stays at $500.

Medicaid Buy-In for Children (MBIC) Program

Resources — No resource test for MBIC.

Income — Effective March 1, 2026:

• MBIC income exclusion — $85 plus one-half of the remaining income.
• Eligibility — No more than 150% FPL based on family size.

These amounts do not include the MBIC income exclusion.

FPL Amounts for Income Eligibility

Ineligible sibling exclusion amount (150% FPL x 2 + $85) = $4,075

FPL Amounts for Premium Determination

MBIC Premiums — No Employer-Sponsored Insurance (ESI)

MBIC Premiums — ESI with State-Paid Health Insurance Premium Program (HIPP)

MBIC Premiums — ESI and No State-Paid HIPP

No MBIC premium.

Medicare Premiums

Effective Jan. 1, 2026

Part A Premium (Hospital Insurance):

• $0 — Most people do not pay a monthly Part A premium because they or a spouse have 40 or more quarters of Medicare-covered employment.
• $565 — Standard Medicare Part A monthly premium cost — The monthly Part A premium for people who are not otherwise eligible for premium-free hospital insurance and who have less than 30 quarters of Medicare-covered employment.
• $311 — Reduced Medicare Part A premium — The monthly Part A premium for people who have 30–39 quarters of Medicare-covered employment.

Part B Premium (Medical Insurance):

• $202.90— 2026 standard Medicare Part B monthly premium.

Staff must use the Medicare Part B amount as verified in the State Online Query (SOLQ).

Part B-ID Premium (Immunosuppressive Drugs only)

• $121.60 – 2026 Standard Medicare Part B-ID monthly premium.

Related Policy

Medicare Part B Premium, H-1800

Community Attendant Services (CAS)

Income — Effective Jan. 1, 2026, total countable income must be no more than the special income limit:

• Individual — $2,982
• Couple — $5,964

Resources — Total countable resources must be no more than the limit:

• Individual — $2,000
• Couple — $3,000

Institutional Living Arrangement

When people are living in a Medicaid certified long-term care facility or receiving Home and Community Based Waiver services.

Individual or Couple Eligibility Budget

Special income limit — The special income limit for a person is equal to or less than 300% of the SSI federal benefit rate.

Income — Effective Jan. 1, 2026, total countable income must be no more than the special income limit:

• Individual — $2,982
• Couple — $5,964

Resources —Total countable resources must be no more than the limit:

• Individual — $2,000
• Couple — $3,000
• Substantial home equity — $752,000
• Transfer of assets (TOA) divisor — $262.37 daily rate effective Sept. 1, 2025.

Note: The transfer of assets daily rate is reviewed every other year.

Co-Payment

Individual or Couple Co-Payment Budget:

• Personal Needs Allowance (PNA)
  • $75 for a nursing facility recipient
  • $75 plus the Protected Earned Income (PEI) amount for a recipient in an ICF/IID facility
  • $85 for a recipient in foster care or assisted living
  • $2,901 for an HCBS waiver recipient
• Guardianship Fees — Varies
• Dependent Allowance — $967
• Incurred Medical Expenses — Varies
• Deduction for Home Maintenance — Up to $967

Spousal Co-payment Budget:

• PNA
  • $75 for a nursing facility recipient
  • $75 plus the PEI amount for a recipient in an ICF/IID facility
  • $85 for a recipient in foster care or assisted living
  • $2,901 for an HCBS waiver recipient
• Guardianship Fees — Varies
• Minimum Monthly Maintenance Needs Allowance (MMMNA) also known as Spousal Allowance — $4,066.50
• Spousal Impoverishment Dependent Allowance — $2,643.75 effective July 1, 2025
• Incurred Medical Expenses — Varies

Calculation of the Spousal Protected Resource Amount (SPRA):

• SPRA is the greater of:
  • one-half of the couple's combined countable resources; or
  • $32,532, the minimum resource amount set by federal law; but
  • cannot exceed $162,660, the maximum resource amount set by federal law.

Income-first MMMNA for SPRA expansion also known as Spousal Allowance — $4,066.50

Related Policy

Personal Needs Allowance (PNA), H-1500
Guardianship Fees, H-1550
Dependent Allowance, H-1600
Deduction for Home Maintenance, H-1700
Incurred Medical Expenses, H-2000
Spousal Impoverishment Dependent Allowance, J-7400