Appendix F 07/13/10
FEDERAL
POVERTY LEVELS
Monthly Levels
(April
1, 2009 until superseded)
Family Size
|
ARKids
A Children
6 & Over & AR
Health Care Access 100% |
ARKids
A Children Under Age 6 133% |
Transitional
Medicaid 185% |
SOBRA Pregnant
Women, Family Planning & ARKids
First B 200% |
|
1 |
902.50 |
1200.33 |
1669.63 |
1805.00 |
|
2 |
1214.17 |
1614.85 |
2246.21 |
2428.34 |
|
3 |
1525.83 |
2029.35 |
2822.79 |
3051.66 |
|
4 |
1837.50 |
2443.88 |
3399.38 |
3675.00 |
|
5 |
2149.17 |
2858.40 |
3975.96 |
4298.34 |
|
6 |
2460.83 |
3272.90 |
4552.54 |
4921.66 |
|
7 |
2772.50 |
3687.43 |
5129.13 |
5545.00 |
|
8 |
3084.17 |
4101.95 |
5705.71 |
6168.34 |
|
9 |
3395.84 |
4516.47 |
6282.30 |
6791.68 |
|
10 |
3707.51 |
4930.99 |
6858.89 |
7415.02 |
|
|
|
|
|
|
|
For each
additional member add: |
311.67 |
414.52 |
576.59 |
623.34 |
AABD MEDICAID CATEGORIES
|
|
ARSeniors Equal
to or Below 80% |
QMB Equal
To or Below 100% |
SMB
Between
100% & 120% |
QI-1
At
least 120% but Less Than 135% |
QDWI
& TB
Equal
To or Below 200% |
Working
Disabled 250%
|
|
|
|
Individual |
722.00 |
902.50 |
1083.00 |
1218.38 |
1805.00 |
2256.25 |
|
|
|
Couple |
971.34 |
1214.17 |
1457.00 |
1639.13 |
2428.34 |
3035.42 |
|
|
|
For each additional family member in
the Working Disabled category add: |
779.18 |
|||||||
Appendix
F 04/01/09
2009 FEDERAL POVERTY LEVELS
Monthly Levels
(April 1, 2009 through
March 31, 2010)
Family Size
|
ARKids
A Children
6 & Over & AR
Health Care Access 100% |
ARKids
A Children Under Age 6 133% |
Transitional
Medicaid 185% |
SOBRA Pregnant
Women, Family Planning & ARKids
First B 200% |
|
1 |
902.50 |
1200.33 |
1669.63 |
1805.00 |
|
2 |
1214.17 |
1614.85 |
2246.21 |
2428.34 |
|
3 |
1525.83 |
2029.35 |
2822.79 |
3051.66 |
|
4 |
1837.50 |
2443.88 |
3399.38 |
3675.00 |
|
5 |
2149.17 |
2858.40 |
3975.96 |
4298.34 |
|
6 |
2460.83 |
3272.90 |
4552.54 |
4921.66 |
|
7 |
2772.50 |
3687.43 |
5129.13 |
5545.00 |
|
8 |
3084.17 |
4101.95 |
5705.71 |
6168.34 |
|
9 |
3395.84 |
4516.47 |
6282.30 |
6791.68 |
|
10 |
3707.51 |
4930.99 |
6858.89 |
7415.02 |
|
|
|
|
|
|
|
For each
additional member add: |
311.67 |
414.52 |
576.59 |
623.34 |
AABD MEDICAID CATEGORIES
|
|
ARSeniors Equal
to or Below 80% |
QMB Equal
To or Below 100% |
SMB
Between
100% & 120% |
QI-1
At
least 120% but Less Than 135% |
QDWI & TB
Equal
To or Below 200% |
Working Disabled 250%
|
|
|
|
Individual |
722.00 |
902.50 |
1083.00 |
1218.38 |
1805.00 |
2256.25 |
|
|
|
Couple |
971.34 |
1214.17 |
1457.00 |
1639.13 |
2428.34 |
3035.42 |
|
|
|
For each additional family member in
the Working Disabled category add: |
779.18 |
|||||||
Appendix
F
2008 FEDERAL POVERTY LEVELS
Monthly Levels
(April 1, 2008 through March
31, 2009)
Family Size
|
ARKids
A Children
6 & Over & AR
Health Care Access 100% |
ARKids
A Children Under Age 6 133% |
Transitional
Medicaid 185% |
SOBRA Pregnant
Women, Family Planning & ARKids
First B 200% |
|
1 |
866.67 |
1152.67 |
1603.33 |
1733.34 |
|
2 |
1166.67 |
1551.67 |
2158.33 |
2333.34 |
|
3 |
1466.67 |
1950.67 |
2713.33 |
2933.34 |
|
4 |
1766.67 |
2349.67 |
3268.33 |
3533.34 |
|
5 |
2066.67 |
2748.67 |
3823.33 |
4133.34 |
|
6 |
2366.67 |
3147.67 |
4378.33 |
4733.34 |
|
7 |
2666.67 |
3546.67 |
4933.33 |
5333.34 |
|
8 |
2966.67 |
3945.67 |
5488.33 |
5933.34 |
|
9 |
3266.67 |
4344.67 |
6043.33 |
6533.34 |
|
10 |
3566.67 |
4743.67 |
6598.33 |
7133.34 |
|
|
|
|
|
|
|
For each
additional member add: |
300.00 |
399.00 |
555.00 |
600.00 |
AABD MEDICAID CATEGORIES
|
|
ARSeniors Equal
to or Below 80% |
QMB Equal
To or Below 100% |
SMB
Between
100% & 120% |
QI-1
At
least 120% but Less Than 135% |
QDWI & TB
Equal
To or Below 200% |
Working Disabled 250%
|
|
|
|
Individual |
693.33 |
866.67 |
1040.00 |
1170.00 |
1733.34 |
2166.67 |
|
|
|
Couple |
933.33 |
1166.67 |
1400.00 |
1575.00 |
2333.34 |
2916.67 |
|
|
|
For each additional family member in
the Working Disabled category add: |
750.00 |
|||||||
2007 FEDERAL POVERTY LEVELS
Monthly Levels
(April 1, 2007 through
March 31, 2008)
Family Size
|
ARKids
A Children
6 & Over & AR
Health Care Access 100% |
ARKids
A Children Under Age 6 133% |
Transitional
Medicaid 185% |
SOBRA Pregnant
Women, Family Planning & ARKids
First B 200% |
|
1 |
850.83 |
1131.60 |
1574.04 |
1701.66 |
|
2 |
1140.83 |
1517.30 |
2110.54 |
2281.66 |
|
3 |
1430.83 |
1903.00 |
2647.04 |
2861.66 |
|
4 |
1720.83 |
2288.70 |
3183.54 |
3441.66 |
|
5 |
2010.83 |
2674.40 |
3720.04 |
4021.66 |
|
6 |
2300.83 |
3060.10 |
4256.54 |
4601.66 |
|
7 |
2590.83 |
3445.80 |
4793.04 |
5181.66 |
|
8 |
2880.83 |
3831.50 |
5329.54 |
5761.66 |
|
9 |
3170.83 |
4217.20 |
5866.04 |
6341.66 |
|
10 |
3460.83 |
4602.90 |
6402.54 |
6921.66 |
|
|
|
|
|
|
|
For each
additional member add: |
290.00 |
385.70 |
536.50 |
580.00 |
AABD MEDICAID CATEGORIES
|
|
ARSeniors Equal
to or Below 80% |
QMB Equal
To or Below 100% |
SMB
Between
100% & 120% |
QI-1
At
least 120% but Less Than 135% |
QDWI & TB
Equal
To or Below 200% |
Working Disabled 250%
|
|
|
|
Individual |
680.66 |
850.83 |
1021.00 |
1148.62 |
1701.66 |
2127.08 |
|
|
|
Couple |
912.66 |
1140.83 |
1369.00 |
1540.12 |
2281.66 |
2852.08 |
|
|
|
For each additional family member in
the Working Disabled category add: |
725.00 |
|||||||
2006 FEDERAL POVERTY LEVELS
Monthly Levels
(April 1, 2006 through
March 31, 2007)
Family Size
|
ARKids
A Children
6 & Over & AR
Health Care Access 100% |
ARKids
A Children Under Age 6 133% |
Transitional
Medicaid 185% |
SOBRA Pregnant
Women, Family Planning & ARKids
First B 200% |
|
1 |
816.67 |
1086.17 |
1510.84 |
1633.34 |
|
2 |
1100.00 |
1463.00 |
2035.00 |
2200.00 |
|
3 |
1383.33 |
1839.83 |
2559.16 |
2766.66 |
|
4 |
1666.67 |
2216.67 |
3083.34 |
3333.34 |
|
5 |
1950.00 |
2593.50 |
3607.50 |
3900.00 |
|
6 |
2233.33 |
2970.33 |
4131.66 |
4466.66 |
|
7 |
2516.67 |
3347.17 |
4655.84 |
5033.34 |
|
8 |
2800.00 |
3724.00 |
5180.00 |
5600.00 |
|
9 |
3083.33 |
4100.83 |
5704.16 |
6166.66 |
|
10 |
3366.66 |
4477.66 |
6228.32 |
6733.32 |
|
|
|
|
|
|
|
For each
additional member add: |
283.33 |
376.83 |
524.16 |
566.66 |
AABD MEDICAID CATEGORIES
|
|
ARSeniors Equal
to or Below 80% |
QMB Equal
To or Below 100% |
SMB
Between
100% & 120% |
QI-1
At
least 120% but Less Than 135% |
QDWI & TB
Equal
To or Below 200% |
Working Disabled 250%
|
|
|
|
Individual |
653.34 |
816.67 |
980.00 |
1102.50 |
1633.34 |
2041.68 |
|
|
|
Couple |
880.00 |
1100.00 |
1320.00 |
1485.00 |
2200.00 |
2750.00 |
|
|
|
For each additional family member in
the Working Disabled category add: |
708.33 |
|||||||
2005 FEDERAL POVERTY
LEVELS
Monthly Levels
(April
1, 2005 through March 31, 2006)
|
Family Size
|
ARKids A Children
6 & Over & AR
Health Care Access 100% |
ARKids A Children Under Age 6 133% |
Transitional
Medicaid 185% |
SOBRA Pregnant
Women, Family Planning & ARKids First B 200% |
|
1 |
797.50 |
1060.68 |
1475.38 |
1595.00 |
|
2 |
1069.17 |
1422.00 |
1977.96 |
2138.34 |
|
3 |
1340.83 |
1783.30 |
2480.54 |
2681.66 |
|
4 |
1612.50 |
2144.63 |
2983.13 |
3225.00 |
|
5 |
1884.17 |
2505.95 |
3485.71 |
3768.34 |
|
6 |
2155.83 |
2867.25 |
3988.29 |
4311.66 |
|
7 |
2427.50 |
3228.58 |
4490.88 |
4855.00 |
|
8 |
2699.17 |
3589.90 |
4993.46 |
5398.34 |
|
9 |
2970.84 |
3951.22 |
5496.05 |
5941.68 |
|
10 |
3242.51 |
4312.54 |
5998.64 |
6485.02 |
|
|
|
|
|
|
|
For each additional member add: |
271.67 |
361.32 |
502.59 |
543.34 |
AABD MEDICAID CATEGORIES
|
|
ARSeniors Equal
to or Below 80% |
QMB Equal
To or Below 100% |
SMB
Between
100% & 120% |
QI-1
At
least 120% but Less Than 135% |
QDWI & TB
Equal
To or Below 200% |
Working Disabled 250%
|
|
|
|
Individual |
638.00 |
797.50 |
957.00 |
1076.63 |
1595.00 |
1993.75 |
|
|
|
Couple |
855.34 |
1069.17 |
1283.00 |
1443.38 |
2138.34 |
2672.93 |
|
|
|
For
each additional family member in the Working Disabled category add: |
679.18 |
|||||||
|
|
|
|
|
|
|
|
|
|
2004 FEDERAL POVERTY LEVELS
Monthly Levels
(April 1, 2004 through March 31, 2005)
FAMILY MEDICAID CATEGORIES
|
Family
Size |
ARKids A Children
6 & Over & AR
Health Care Access 100% |
ARKids A Children Under Age 6 & 133% |
Transitional
Medicaid 185% |
SOBRA Pregnant
Women, Family Planning & ARKids First B 200% |
|
1 |
775.83 |
1031.85 |
1435.29 |
1551.66 |
|
2 |
1040.83 |
1384.30 |
1925.54 |
2081.66 |
|
3 |
1305.83 |
1736.75 |
2415.79 |
2611.66 |
|
4 |
1570.83 |
2089.20 |
2906.04 |
3141.66 |
|
5 |
1835.83 |
2441.65 |
3396.29 |
3671.66 |
|
6 |
2100.83 |
2794.10 |
3886.54 |
4201.66 |
|
7 |
2365.83 |
3146.55 |
4376.79 |
4731.66 |
|
8 |
2630.83 |
3499.00 |
4867.04 |
5261.66 |
|
9 |
2895.83 |
3851.45 |
5357.29 |
5791.66 |
|
10 |
3160.83 |
4203.90 |
5847.54 |
6321.66 |
|
|
|
|
|
|
|
For each additional member
add: |
265.00 |
352.45 |
490.25 |
530.00 |
AABD MEDICAID CATEGORIES
|
|
ARSeniors Equal
to or Below 80% |
QMB Equal
To or Below 100% |
SMB Between
100% & 120% |
QI-1 At
least 120% but Less Than 135% |
QDWI Equal
To or Below 200% |
Working
Disabled
250% |
|
|
Individual |
620.66 |
775.83 |
931.00 |
1047.37 |
1551.66 |
1939.58 |
|
|
Couple |
832.66 |
1040.83 |
1249.00 |
1405.12 |
2081.66 |
2602.08 |
|
|
For
each additional family member in the Working Disabled category add: |
662.50 |
||||||
2003 FEDERAL POVERTY LEVELS
Monthly Levels
(April 1, 2003 through March 31, 2004)
FAMILY
MEDICAID CATEGORIES
|
Family
Size |
ARKids A Children
6 & Over & AR
Health Care Access 100% |
ARKids A Children Under Age 6 & Family
Planning 133% |
Transitional
Medicaid 185% |
SOBRA Pregnant
Women, Family Planning & ARKids First B 200% |
|
1 |
748.33 |
995.28 |
1384.42 |
1496.66 |
|
2 |
1010.00 |
1343.30 |
1868.50 |
2020.00 |
|
3 |
1271.67 |
1691.32 |
2352.58 |
2543.34 |
|
4 |
1533.33 |
2039.33 |
2836.67 |
3066.66 |
|
5 |
1795.00 |
2387.35 |
3320.75 |
3590.00 |
|
6 |
2056.67 |
2735.37 |
3804.83 |
4113.34 |
|
7 |
2318.33 |
3083.38 |
4288.92 |
4636.66 |
|
8 |
2580.00 |
3431.40 |
4773.00 |
5160.00 |
|
9 |
2841.67 |
3779.42 |
5257.09 |
5683.34 |
|
10 |
3103.34 |
4127.44 |
5741.18 |
6206.68 |
|
|
|
|
|
|
|
For each additional member
add: |
261.67 |
348.02 |
484.09 |
523.34 |
AABD MEDICAID
CATEGORIES
|
|
ARSeniors Equal
to or Below 80% |
QMB Equal
To or Below 100% |
SMB Between
100% & 120% |
QI-1 At
least 120% but Less Than 135% |
QDWI Equal
To or Below 200% |
Working
Disabled 250% |
|
|
Individual |
598.66 |
748.33 |
898.00 |
1010.25 |
1496.66 |
1870.82 |
|
|
Couple |
808.00 |
1010.00 |
1212.00 |
1363.50 |
2020.00 |
2525.00 |
|
|
For
each additional family member in the Working Disabled category add: |
654.17 |
||||||
2002 FEDERAL POVERTY LEVELS
Monthly Levels
(April
1, 2002 through March 31, 2003)
FAMILY MEDICAID CATEGORIES
|
Family
Size |
ARKids A Children
6 & Over & AR
Health Care Access 100% |
ARKids A Children Under Age 6 & Family
Planning 133% |
Transitional
Medicaid 185% |
SOBRA Pregnant
Women & ARKids First B 200% |
|
1 |
738.33 |
981.98 |
1,365.92 |
1,476.66 |
|
2 |
995.00 |
1,323.35 |
1,840.75 |
1,990.00 |
|
3 |
1,251.67 |
1,664.72 |
2,315.58 |
2,503.34 |
|
4 |
1,508.33 |
2,006.08 |
2,790.25 |
3,016.66 |
|
5 |
1,765.00 |
2,347.45 |
3,265.25 |
3,530.00 |
|
6 |
2,021.67 |
2,688.82 |
3,740.08 |
4,043.34 |
|
7 |
2,278.33 |
3,030.18 |
4,214.92 |
4,556.66 |
|
8 |
2,535.00 |
3,371.55 |
4,689.75 |
5,070.00 |
|
9 |
2,791.67 |
3,712.92 |
5,164.59 |
5,583.34 |
|
10 |
3,048.34 |
4,054.29 |
5,639.43 |
6,096.68 |
|
|
|
|
|
|
|
For each additional member
add: |
256.67 |
341.37 |
474.84 |
513.34 |
AABD MEDICAID CATEGORIES
|
|
ARSeniors Equal
to or Below 80% |
QMB Equal
To or Below 100% |
SMB Between
100% & 120% |
QI-1 At
least 120% but Less Than 135% |
QDWI Equal
To or Below 200% |
Working
Disabled 250% |
|
|
Individual |
590.66 |
738.33 |
886.00 |
996.75 |
1,476.67 |
1,845.82 |
|
|
Couple |
796.00 |
995.00 |
1,194.00 |
1,343.25 |
1,990.00 |
2,487.50 |
|
|
For
each additional family member in the Working Disabled category add: |
641.67 |
||||||
2001 FEDERAL POVERTY LEVELS
Monthly Levels
(April
1, 2001 through March 31, 2002)
FAMILY MEDICAID CATEGORIES
|
Family
Size |
ARKids A Children
6 & Over Born After 9/30/82 & AR
Health Care Access 100% |
ARKids A Children up to Age 6 & Family
Planning
|
Transitional
Medicaid 185% |
SOBRA Pregnant
Women & ARKids First B 200% |
|
1 |
715.83 |
952.05 |
1,324.29 |
1,431.66 |
|
2 |
967.50 |
1,286.78 |
1,789.88 |
1,935.00 |
|
3 |
1,219.17 |
1,621.50 |
2,255.46 |
2,438.34 |
|
4 |
1,470.83 |
1,956.20 |
2,721.04 |
2,941.66 |
|
5 |
1,722.50 |
2,290.93 |
3,186.63 |
3,445.00 |
|
6 |
1,974.17 |
2,625.65 |
3,652.21 |
3,948.34 |
|
7 |
2,225.83 |
2,960.35 |
4,117.79 |
4,451.66 |
|
8 |
2,477.50 |
3,295.08 |
4,583.38 |
4,955.00 |
|
9 |
2,729.17 |
3,629.80 |
5,048.96 |
5,458.34 |
|
10 |
2,980.84 |
3,964.52 |
5,514.54 |
5,961.68 |
|
For each additional member
add: |
251.67 |
334.72 |
465.58 |
503.34 |
AABD MEDICAID CATEGORIES
|
|
QMB Equal
To or Below 100% |
SMB Between
100% & 120% |
QI-1 At
least 120% but Less Than 135% |
QI-2 At
least 135% but Less Than 175% |
QDWI Equal
To or Below 200% |
Working
Disabled
|
|
Individual |
715.83 |
859.00 |
966.37 |
1,252.70 |
1,431.67 |
1,789.57 |
|
Couple |
967.50 |
1,161.00 |
1,306.13 |
1,693.13 |
1,935.00 |
2,418.75 |
|
For
each additional family member in the Working Disabled category add: |
629.18 |
|||||
Monthly
Levels
(April
1, 2000 through March 31, 2001)
FAMILY MEDICAID CATEGORIES
|
Family
Size |
SOBRA 100% |
SOBRA 133% |
Transitional
Medicaid 185% |
ARKids First 200% |
|
1 |
695.83 |
925.45 |
1,287.29 |
1,391.66 |
|
2 |
937.50 |
1,246.88 |
1,734.38 |
1,875.00 |
|
3 |
1,179.17 |
1,568.30 |
2,181.46 |
2,358.34 |
|
4 |
1,420.83 |
1,889.70 |
2,628.54 |
2,841.66 |
|
5 |
1,662.50 |
2,211.13 |
3,075.63 |
3,325.00 |
|
6 |
1,904.17 |
2,532.55 |
3,522.71 |
3,808.34 |
|
7 |
2,145.83 |
2,853.95 |
3,969.79 |
4,291.66 |
|
8 |
2,387.50 |
3,175.38 |
4,416.88 |
4,775.00 |
|
9 |
2,629.17 |
3,496.80 |
4,863.96 |
5,258.34 |
|
10 |
2,870.83 |
3,818.20 |
5,311.04 |
5,741.66 |
|
For each additional member
add: |
241.67 |
321.42 |
447.09 |
483.34 |
AABD MEDICAID CATEGORIES
|
|
QMB |
SMB |
QI-1 |
QI-2 |
QDWI |
|
Individual |
695.83 |
835.00 |
939.37 |
1,217.70 |
1,391.66 |
|
Couple |
937.50 |
1,125.00 |
1,265.63 |
1,640.63 |
1,875.00 |
FAMILY MEDICAID CATEGORIES
|
Family
Size |
SOBRA 100% |
SOBRA 133% |
Transitional
Medicaid 185% |
ARKids First 200% |
|
1 |
686.67 |
913.27 |
1,270.34 |
1,373.34 |
|
2 |
921.67 |
1,225.82 |
1,705.09 |
1,843.34 |
|
3 |
1,156.67 |
1,538.37 |
2,139.84 |
2,313.34 |
|
4 |
1,391.67 |
1,850.92 |
2,574.59 |
2,783.34 |
|
5 |
1,626.67 |
2,163.47 |
3,009.34 |
3,253.34 |
|
6 |
1,861.67 |
2,476.02 |
3,444.09 |
3,723.34 |
|
7 |
2,096.67 |
2,788.57 |
3,878.84 |
4,193.34 |
|
8 |
2,331.67 |
3,101.12 |
4,313.59 |
4,663.34 |
|
9 |
2,566.67 |
3,413.67 |
4,748.34 |
5,133.34 |
|
10 |
2,801.67 |
3,726.22 |
5,183.09 |
5,603.34 |
|
For each additional member
add: |
235.00 |
312.55 |
434.75 |
470.00 |
AABD MEDICAID CATEGORIES
|
|
QMB |
SMB |
QI-1 |
QI-2 |
QDWI |
|
Individual |
686.67 |
824.00 |
927.00 |
1,201.67 |
1,373.34 |
|
Couple |
921.67 |
1,106.00 |
1,244.25 |
1612.92 |
1,843.34 |