250% Federal Poverty Level - Medicaid Insurance for Workers with Disabilities

469-000-213

Working Disabled Medicaid Premium Payment Beneficiaries

Income Limit

Number of Individuals

Income

1

$2,327

2

3,152

3

3,977

4

4,802

5

5,627

6

6,452

7

7,277

8

8,102

9

8,927

10

9,752

11

10,577

12

11,402

{Rev. 1/1/12}