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Attachment IV'~ Page 1 INCO~LE ELIGIBILITY GUIDELINES AND PROCEDURES Local agenc(ea are encouraged to' coordinate ~IC income eligibility procedures with loc'al agency income procedures for services to mothers and children (i.eo, Haternal Health. Child Ilealth. Family Planning and OIlS Reimbursement Services). In addition if you are an agency using 185~ of' the federal poverty scale, for those' applicable who hold current Hedicaid' eligibility, it is not necessary to screen income. If yop are c~rrently using an income eligibility scale less than 185~ of poverty, you must screen all VIC applicants for income eligibility. See~tCachment IV-O-l(b)o. A. Local.Agency Income Eligibility Level Lore! agencies may choose their level of income eligibility within the range of 185 percent t~a~imum) and 100~ (minimum) of the Of/ice of - Hanagement and Budget (OF~) poverty guidelines. Local agencies ~ho choose a level of income below 185 percent of poverty must align the ~IC income gltgibllity criteria with that of another program whose gross income level for free or reduced-price health care is not lo,er than 100 percent of poverty. Local agencies that have no upper income limit for those who receive free or reduced-price health care for other programs must use 185 percent of poverty for VIC income eligibility limits. Income eligibility for the ~IC Program mast be based on gross income. (Income before any deductions.) ~OVERTY. INCO~ CUIDSLIN~ Effective 7/1/89 Source: Vol. 54. No. 31 Federal Register, 2/16/89 100 Percent of Poverty (~inimum Level) Family Size . Year Honth ~eek I 5,980 498.33 115.00. 2 8,020 668,33 154,23 3 10.060 838.33 t93.~6 ~ 12,100 1~008~33 232.69 5 141140 1,178~33 271.92 6 16,180 1,348o33 311.1§ 7 ' 18,220 1,518;33 ... 350,38 8 20,260 1,688,33 389,62 For Each Additional Family Hember Add 2,040 170.00 39.23