Health Reform WK-EDGE CMCS details 2017 HHS federal poverty level guidelines
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Monday, April 3, 2017

CMCS details 2017 HHS federal poverty level guidelines

The 2017 federal poverty levels (FPLs) reflect a 1.3 percent price increase between calendar years 2015 and 2016, according to an information bulletin released by the Center for Medicaid and CHIP Services (CMCS) discussing the release of the FPLs by HHS on January 31, 2017 (82 FR 8831). The guidelines are provided at least annually by HHS pursuant to Sec. 673(2) of the Omnibus Budget Reconciliation Act (OBRA) of 1981 and are used to determine eligibility for programs like Medicaid and the Children’s Health Insurance Program (CHIP), and in recent years, health coverage purchased through the federally-facilitated marketplace. CMCS also provided new standards for dual eligible individuals eligible for coverage under both Medicaid and Medicare (CMSC Informational Bulletin, March 24, 2017).

Eligibility for Medicaid and CHIP both rely on FPLs. Further, FPLs are used to determine eligibility for tax credits under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) advance payments of the premium tax credit (APTC) and cost-sharing reductions for the purchase of health coverage through the marketplace. FPLs from 2016 will continue to be used for tax credit purposes through 2017 enrollment. Although Medicaid and CHIP eligibility determinations also have an effect on the marketplace, the 2017 FPLs started being used for those purposes on February 26, 2017.

Low income seniors and disabled individuals may be eligible for coverage under both Medicaid and Medicare. FPLs also provide the basis for eligibility for dual eligibles. Several categories of eligibility exist, each with its own specific figures and, often, other limitations: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individuals (QI), and Qualified Disabled Working Individual (QDWI). More information on dual eligibility, and the income guidelines for each category of dual eligible, is available on the Medicaid.gov website.

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