Policy                                                                           Issuance Number: MS 04-02

Medical Services Policy Manual                           Issuance Date: April 1, 2004

From: Joni Jones, Director                                       Expiration Date: Until Superseded

Subj: 2004 Federal Poverty Levels

Revised [Appendix F,Chart]  provides the 2004 Federal Poverty Level income guidelines to be effective April 1, 2004 for the following categories. 

(a)               Medicare Savings Categories

ARSeniors, QMB, SMB and QI-1 – MS 23110 #7

QDWI – MS 23515 #4

(b)               Working Disabled – MS 28015 #7

(c)               Transitional Medicaid – MS 2062.3

(d)               ARKids A and B – MS 16040 #8

(e)               SOBRA Pregnant Women – PD MS 01-11

(f)                 Family Planning Demonstration Waiver – MS 12500

(g)               Tuberculosis – MS 31110

Inquiries to: Jack Tiner, 501-682-8259

Diana Teal, 501-682-1562

Carmen Banks, 501-682-8258

Carla Droughn, 501-682-8254