2026 Dual Eligible Standards
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Standards for Maryland Medicaid eligibility and financial limits for individuals dually eligible for Medicare and Medicaid (QMB, SLMB, QI, QDWI) and related medically needy schedules; applies to Maryland Medicaid program.
No material clinical or coverage changes in this revision.
Eligibility and Medically Needy Schedules
Medically Needy Schedules
Medically Needy income, consideration period, and resource standards (Non‑MAGI) are provided in Schedules MA‑1, MA‑1A, and MA‑2.
ALL of the following
- Schedule MA-1: Medically Needy Income Standards (Non-MAGI) — monthly and annual income standards by household size. Examples: 1 person: $4,200 annual / $350 monthly; 2 persons: $4,700 annual / $392 monthly; 3 persons: $5,200 annual / $434 monthly; additional persons: each additional person +$732 annual / +$61 monthly (see full table).see schedule
- Consideration Periods (Schedule MA-1A / related tables): Six-month dependent consideration period amounts by household size. Examples: 1 person: $2,100; 2 persons: $2,350; 3 persons: $2,600; each additional person +$366.see schedule
- Schedule MA-2: Medically Needy Resource Standards (Non-MAGI) — resource limits by household size. Examples: 1 person: $2,500; 2 persons: $3,000; 3 persons: $3,100; each additional person +$100.see schedule
SNF payment schedule (MA-6)
Skilled nursing facility (SNF) payment averages and supporting notes are provided in Schedule MA‑6.
ALL of the following
- MA-6 Average amounts — Effective 7/1/25: Average monthly amount payable for care in a skilled nursing facility = $12,501.$12,501 monthly
- MA-6 Average amounts — Effective 7/1/25: Average daily amount payable for care in a skilled nursing facility = $411.$411 daily
- Note: MA-6 figures are based on the Genworth 2024 Cost of Care Survey (December 2024) as cited in the schedule.
Source: Genworth 2024 Cost of Care Survey
- Schedule MA-6 also includes related maintenance and utility standards used for community spouse calculations (see schedule for full details).
Applied numeric standards
Numeric standards and limits included in the schedules are applied for Medicaid maintenance, spousal impoverishment, and benefit calculations.
ALL of the following
- MA-6 numeric standards: Average monthly SNF amount = $12,501 (effective 7/1/25).$12,501 monthly
- MA-6 numeric standards: Average daily SNF amount = $411 (effective 7/1/25).$411 daily
- Spousal Impoverishment (MA-8) resource limits: Maximum Spousal Share, Resources = $162,660 (effective 1/1/26).$162,660
- Spousal Impoverishment (MA-8) resource limits: Minimum Spousal Share, Resources = $32,532 (effective 1/1/26).$32,532
- Schedules reference actuarial tables (Schedule MA-9A, Period Life Table, 2021) for life‑expectancy and related calculations used in trustee/actuarial work.
See Schedule MA-9A (Period Life Table, 2021)
Actuarial reference (no coverage criteria)
Actuarial reference data is provided; no direct coverage criteria are specified in this excerpt.
Used as cited in the 2024 Trustees Report
Home equity exclusion threshold
Asset threshold affecting exclusion from long‑term care coverage:
Home equity above this threshold is considered in exclusion determinations for long-term care coverage.
Monetary Standards and Code Tables
| Average monthly amount payable for care in a skilled nursing facility: Effective 7/1/25, 1 = Average $12,501 | |
| Average daily amount payable for care in a skilled nursing facility: Effective 7/1/25, 1 = Average $411 |
| No codes listed |
| No codes listed |
Provider Notices and Actionable Highlights
Dual Eligible Standards overview
This document lists the financial eligibility standards and schedules for dual-eligible categories (QMB, SLMB, QI, QDWI) and the medically needy resource/consideration schedules used by Maryland Medicaid to determine eligibility and benefit calculations.
MA-6 Skilled Nursing Facility Payment Amounts
Schedule MA-6 specifies the average amounts payable for skilled nursing facility care effective 7/1/25: average monthly amount $12,501 and average daily amount $411.
- Average monthly amount payable for care in a skilled nursing facility: $12,501 (effective 7/1/25).
- Average daily amount payable for care in a skilled nursing facility: $411 (effective 7/1/25).
- Note: figures based on the Genworth 2024 Cost of Care Survey (Dec 2024).
Spousal Impoverishment Resource Limits (MA-8)
Spousal impoverishment resource limits are set in Schedule MA-8: Maximum spousal share (resources) = $162,660 and Minimum spousal share (resources) = $32,532, both with effective date 1/1/26.
- Maximum Spousal Share, Resources = $162,660 (Effective 1/1/26).
- Minimum Spousal Share, Resources = $32,532 (Effective 1/1/26).
Actuarial data citation
The schedules cite the Social Security Administration period life table for 2021 as used in the 2024 Trustees Report for actuarial reference and life-expectancy estimates.
- "The period life expectancy at a given age for 2021..." — Source: SSA, Estimates from the 2024 Trustees Report.
- Schedule MA-9A references the Period Life Table, 2021, as used in the 2024 Trustee Report.
Schedule reference
Refer to Schedule MA-10 for related administrative schedule details referenced in this document.
Glossary and Defined Terms
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