1 Income Standard

Medicaid and CHIP Program (MACPro) (CMS-10434)

QSSI-MACPro-PRA-S13a

GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility

OMB: 0938-1188

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Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
S13a - Income Standard PRA Document
Version 1.0
08/18/2017

Document Number: 219-QSSI-MACPro-R5.1-S13a-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. S13a - Income Standard Screenshots .................................................................... 1
1.1
1.2
1.3
1.4

Income Standard – Path 1............................................................................... 1
Income Standard – Path 2............................................................................... 2
Income Standard – Path 3............................................................................... 2
Income Standard – Path 4............................................................................... 3

List of Figures
Figure 1: Income Standard – Path 1................................................................................ 1
Figure 2: Income Standard – Path 2................................................................................ 2
Figure 3: Income Standard – Path 3................................................................................ 2
Figure 4: Income Standard – Path 4................................................................................ 3

List of Tables
No table of figures entries found.

S13a - Income Standard PRA Document Version 1.0

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Income Standard – Path 1

1. S13a - Income Standard Screenshots
1.1

Income Standard – Path 1

Figure 1: Income Standard – Path 1

S13a - Income Standard PRA Document Version 1.0

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1.2

Income Standard – Path 2

Income Standard – Path 2

Figure 2: Income Standard – Path 2

1.3

Income Standard – Path 3

Figure 3: Income Standard – Path 3

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1.4

Income Standard – Path 4

Income Standard – Path 4

Figure 4: Income Standard – Path 4

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