Medically Needy Income Level

The following figures are used on Form DA-3M and side 1 of Form DA-4M.

Number of Individuals

One Month

Six Months

1

$392.00 

$2,352.00

2

392.00 

2,352.00

3

492.00 

2,952.00

4

584.00 

3,504.00

5

675.00 

4,050.00

6

775.00 

4,650.00

7

867.00 

5,202.00

8

967.00 

5,802.00

9

1,059.00

6,354.00

10

1,150.00

6,900.00

Each additional individual

91.00 

546.00 

{2/1/00}