ELIGIBILITY STANDARDS DESK AID	Effective 10/01/2015	
ALTCS
FEDERAL BENEFIT RATES (FBR)	
 	Eff. 1/1/13 to 12/31/13	Eff. 1/1/14 to 12/31/14	Eff. 1/1/15 to 12/31/15	
1.       Individual FBR/Single parent allocation	$710.00	$721.00	$733.00	
2.       Couple FBR/2 parent allocation	$1,066.00	$1,082.00	$1,100.00	
3.       Institutional FBR	$30.00	$30.00	$30.00	
4.       300% Individual FBR	$2,130.00	$2,163.00	$2,199.00	
5.       Child Allocation	$356.00	$361.00	$367.00	
6.       15% of Individual FBR	$106.50	$108.15	$109.95	
MEDICARE PART B PREMIUMS	
Eff.  1/1/13 – 12/31/13	Eff. 1/1/14 - 12/31/14	Eff. 1/1/15 - 12/31/15	
$104.90	$104.90	$104.90	
MEDICARE PART D EXTRA HELP SUBSIDY AMOUNT FOR ARIZONA	
Eff. 1/1/13 – 12/31/13	Eff. 1/1/14 – 12/31/14	Eff. 1/1/15 – 12/31/15	
$29.41	$27.49	$32.89	
COMMUNITY SPOUSE STANDARDS	
 	Eff. 1/1/13 to 12/31/13	Eff. 1/1/14 to 12/31/14	Eff. 1/1/15 to 12/31/15	
Minimum CSRD	$23,184.00	$23,448.00	$23,844.00	
Maximum CSRD	$115,920.00	$117,240.00	$119,220.00	
Maximum MMMNA	$2,898.00	$2,931.00	$2,981.00	
 	Eff. 10/1/13	Eff. 10/1/14	Eff. 10/1/15	
Standard Utility Allowance	$341.00	$341.00	$271.00	
 	Eff. 7/1/13 to 6/30/14	Eff. 7/1/14 to 6/30/15	Eff. 7/1/15 to 6/30/16	
Monthly Spousal Need (MSN)	$1,939.00	$1,967.00	$1,992.00	
30% of the Monthly Spousal Need for Excess Shelter Allowance	$582.00	$590.00	$598.00	
Maximum Family Allowance for a Dependent With No Income	$646.00	$656.00	$664.00	
AVERAGE PRIVATE PAY RATES	HOME MAINTENANCE ALLOWANCE	
Location	10/1/13	10/1/14	10/1/15	Eff. 1/1/89 to 6/30/93	Eff. 7/1/93 to Present	
Maricopa, Pima, Pinal	$6,648.77	$6,726.48	$6,726.48	$138.00	$210.00	
Balance of State	$5,595.31	$5,575.29	$5,575.29			
SSI MAO/MCS
Actual income may be higher than the following income standards because there is a $20 standard deduction and other deductions for earned income and child allocations.
SSI-MAO NON-CASH AND QMB INCOME STANDARDS	SLMB INCOME STANDARDS	
 	Eff. 4/1/13 to 3/31/14	Eff. 4/1/14 to 1/31/15	Eff. 2/1/15 	Eff. 4/1/13 to 3/31/14	Eff. 4/1/14 to 1/31/15	Eff. 2/1/15	
No. Of People in Household	100% of FPL: Monthly	100% of FPL: Monthly	100% of FPL: Monthly	Greater than 100%, Less than or equal to 120% of FPL: Monthly	Greater than 100%, Less than or equal to 120% of FPL: Monthly	Greater than 100%, Less than or equal to 120% of FPL: Monthly	
1	$958.00	$973.00	$981.00	$958.01 - $1,149.00	$973.01 - $1,167.00	$981.01 - $1,177.00	
2	$1,293.00	$1,311.00	$1,328.00	$1,261.01 - $1,513.00	$1,311.01 - $1,573.00	$1,328.01 - $1,593.00	
QUALIFIED INDIVIDUAL STANDARDS	
 	Qualified Individual – 1 (QI-1)	
No. Of People in Household	Eff. 4/1/13 to 3/31/14	Eff. 4/1/14 to 1/31/15	Eff. 2/1/15 	
	Greater than 120%, Less than or equal to 135% of FPL: Monthly	Greater than 120%, Less than or equal to 135% of FPL: Monthly	Greater than 120%, Less than or equal to 135% of FPL: Monthly	
1	$1,149.01 - $1,293.00	$1,167.01 - $1,313.00	$1,177.01 - $1,325.00	
2	$1,551.01 - $1,749.00	$1,573.01 - $1,770.00	$1,593.01 - $1,793.00