Payors and Providers wait for the release of the poverty guidelines each year to update patient financial assistance and eligibility information within their forms and systems. The 2022 Poverty Guidelines went into effect on January 12, 2022, and are now posted at https://aspe.hhs.gov/poverty-guidelines.
Poverty guidelines are issued each year in the Federal Register by the Department of Health and Human Services (HHS). The federal poverty guidelines (FPG) are a simplification of the poverty thresholds, primarily for administrative use, like determining income eligibility for needs-based programs. Such programs include, but are not limited to, Medicaid, Children’s Health Insurance Program (CHIP), Supplemental Nutrition Assistance Program (SNAP), and Marketplace subsidies.
Below is a table of the new 100 percent of federal poverty guidelines. Other guidelines can be easily calculated using multiplication. For example, 138 percent can be obtained by multiplying 1.38 by the 100 percent number for the family size needed. For example, let’s use a family of four where Mom is applying for a Medicaid program whose income limit is 138 percent. The 100 percent poverty guideline for a family of four (below) is $27,750. We would multiply $27,750 times 1.38 to obtain the income limit equal to 138 percent ($38,295).
2022 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA
PERSONS IN FAMILY/HOUSEHOLD
|For families/households with more than 8 persons, add $4,720 for each additional person.|
The poverty thresholds are the original federal poverty measure and are updated annually for inflation using the Consumer Price Index (CPI) published by the U.S. Bureau of Labor Statistics (BLS). BLS defines CPI as, “a measure of the average change over time in the prices paid by urban consumers for a market basket of consumer goods and services.” It is used to measure inflation, as an economic barometer, and as an indicator of the effectiveness of government policy. The CPI influences wages, Social Security payments, pensions, and much more.
On January 14, 2022, the HHS Secretary, Xavier Becerra, renewed the COVID Public Health Emergency until April 16, 2022. It is renewed in 90-day increments and was set to expire January 16, 2022. In exchange for an additional 6.2 percentage point increase in their Federal Medical Assistance Percentage (FMAP), states agreed not to disenroll Medicaid beneficiaries, with limited exceptions (“continuous enrollment”). State Medicaid rosters are growing, and Medicaid Managed Care Plans are increasingly adding more members. The increase in the FPG will add more members, but also allow more members to retain coverage once continuous enrollment ends. States recognize the increase in the FPG at different times, with April being a very popular month.
Our teams at Centauri Health Solutions have decades of experience in Medicaid eligibility and enrollment. We look forward to helping you navigate the complexities of the FPG, Medicaid, continuous eligibility, and Medicaid redeterminations when the Public Health Emergency ends.
Shanna Hanson, FHFMA, ACB
Manager, Business Knowledge
Centauri Health Solutions, Inc.