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2007 POVERTY LEVELS WILL AFFECT ELIGIBILITY FOR MANY FEDERAL HEALTH PROGRAMS
New federal poverty level (FPL) guidelines published January 24, 2007 will
affect eligibility levels for many public benefits, including health benefits
for older people and people with disabilities. 72 Fed. Reg. 3147, (January 24,
2007). The new numbers are effective when published, but each program that
relies on them may use a different effective date.
The published poverty levels merely state a dollar figure for different sized
family units. They do not address issues of what income is included, what
deductions from income are allowed, who is included in a family unit or other
use issues. These questions are addressed by the individual programs relying
on the poverty guidelines. The amounts given below apply to the 48 contiguous
states and Washington, DC. Rates for Alaska and Hawaii are slightly higher. A
complete list of FPLs is available at
<http://aspe.hhs.gov/poverty/07poverty.shtml>.
Federal health programs affecting older people and people with disabilities
that rely on federal poverty guidelines:
Full Medicaid:
Poverty Level Aged and Disabled (PLAD): States can choose to provide full
Medicaid benefits to aged and disabled individuals with incomes up to 100% of
the federal poverty level (FPL). For states choosing 100% FPL as their
ceiling, eligibility levels for 2007 will be $850.83/month ($10,210/year) for
an individual; to $1140.83/month ($13,690/year) for a couple.
Amounts protected for the at-home spouse of a Medicaid nursing facility
resident: Medicaid law allows for certain levels of income and resources to be
protected for the community spouse of a nursing facility resident whose care is
paid for by Medicaid and who otherwise would have to pay most of her/his income
to the facility. The minimum amount of income protected is 150% FPL for two
people ($1,711.25/month); states must use this amount beginning July 1, 2007
and they may use it immediately. If they do not use it immediately, they will
continue to use $1,650. Other protected amounts for 2006, not linked to FPL,
are maximum monthly protected income, $2.541, minimum resource allowance,
$20,328, and maximum resource allowance, $101,640.
Medicare Savings Programs:
Qualified Medicare Beneficiaries (QMBs): States must be responsible for all
Medicare cost-sharing for Medicare Beneficiaries with incomes up to 100% FPL
and limited resources. For this group, the increase will also be to
$850.83/month ($10,210/year) for an individual; $1.140.83/month ($13,690) for a
couple.
Specified Low-income Medicare Beneficiaries (SLMBs): States must pay the
Medicare Part B premium for Medicare beneficiaries with incomes between 100%
FPL and 120% FPL and limited resources. The new limit for this group will be
$1,021/month ($12,252/year) for an individual; $1,369/month ($16,428/year) for
a couple.
Qualified Individual (QI): States have a limited amount of money from which
they must pay, on a first come, first served basis, Medicare Part B premium for
Medicare beneficiaries with incomes between 120% FPL and 135% FPL and limited
resources. The limit for this group is $1,148.63/month ($13,783.50/year) for
an individual; $1,540.13/month ($18,482/year) for a couple.
Qualified Disabled and Working Individual (QDWI): States must pay the Medicare
Part A premium for certain working disabled Medicare beneficiaries who have
exhausted their entitlement to premium-free Part A benefits and whose incomes
do not exceed 200% FPL. The new limit for this group is $1,701.67/month
($20,420/year) for an individual; $2,281.67/month ($27,380/year) for a couple.
Add $20 to each of the monthly amounts listed above to determine the actual
eligibility limit, since applicants are allowed a $20 disregard from any income
before their income is measured against the poverty levels. Couples only get
one $20 disregard.
Part D Low-income Subsidies:
Full Subsidy: Medicare Part D provides a full drug subsidy with low
co-payments to Medicare beneficiaries with incomes up to 135% FPL and limited
resources. For those individuals, the 2007 eligibility limit is
$1,148.63/month ($13,783.50/year) for an individual; $1,540.13/month
($18,482/year) for a couple.
Partial Subsidy: Medicare Part D provides a partial subsidy of premium,
deductible and co-insurance to Medicare beneficiaries with incomes up to 150%
FPL and limited (but higher than allowed for full subsidy) resources. The
income limit for this group is $1,276.25/month ($15,315/year) for an
individual; $1,711.25/month ($20,535/year) for a couple.
Unlike rules for Medicare Savings Programs, which allow for a family unit of
only one or two, eligibility rules for Part D subsidies will recognize larger
family units, to the extent that those family members rely on the applicant or
her spouse for one half of their financial support. To calculate the levels
for larger family units, start with the yearly amount for one ($10,210), add
$3,480 for each additional family member, multiply by the applicable percentage
of poverty (135% or 150%) and divide the result by 12 for a monthly amount.
The 2007 poverty guidelines will be used to compute Part D low-income subsidies
for the rest of 2007 and for the early months of 2008, until new guidelines are
published. Applications filed in late 2006 that failed 2006 income tests have
been held by the Social Security Administration for evaluation using the 2007
guidelines.
For more information, contact Patricia Nemore in the Center for Medicare
Advocacy's Washington, DC office at (202) 216-0028 or <mailto:[EMAIL
PROTECTED]>.
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