QMC

What is the Federal Poverty Level for purposes of Medicaid?

What exactly is Federal Poverty Level and how does it work? The poverty guidelines are a version of the poverty thresholds and the poverty line used by federal agencies for administrative purposes, such as determining eligibility for federal assistance programs. They are useful because poverty thresholds for one calendar year are not published until the summer of the next calendar year; poverty guidelines, on the other hand, allow agencies to work with more timely data.

Poverty guidelines were issued by the OEO starting in December 1965. After the Omnibus Budget Reconciliation Act of 1981, responsibility for issuing the guidelines was transferred to the Department of Health and Human Services. Poverty rates are also referred to as the “federal poverty level” (FPL), but the HHS discourages that term as ambiguous.

The Federal poverty guidelines are also adjusted according to the number of people in the household. The current income FPL for a family size of 1 in the 48 contiguous states (which includes Missouri) is $14,580 (Alaska and Hawaii have separate higher levels), for a family of 2 is $19,720, 3 is $23,860, 4 is $30,000, and the levels rise from there for each additional person.

Statistics compiled by the Census Bureau show that the FPL among various ethnic and demographic groups as follows:

  • 5.4% of all white persons (which includes white Hispanics),

  • 10.7% of all black persons (which includes black Hispanics),

  • 14.9% of all Hispanic persons (of any race)[88] living in poverty.

Among single-parent (male or female) families: 26.6% lived in poverty.[85] This number varied by race and ethnicity as follows:

  • 22.5% of all white persons (which includes white Hispanics),

  • 44.0% of all black persons (which includes black Hispanics),

  • 33.4% of all Hispanic persons (of any race)[89] living in poverty.

Among individuals living alone: 19.1% lived in poverty.

This number varied by race and ethnicity as follows:

  • 18% of white persons (which includes white Hispanics),

  • 28.9% of black persons (which includes black Hispanics)

  • 27% of Hispanic persons (of any race) are living in poverty.

These poverty thresholds are used to determine eligibility for a variety of low income programs, including Medicaid and other support and healthcare programs. For Missourians, the Medicaid programs are administered by MO Healthnet, and the Department of Social Services.

For purposes of long term care vendor assistance in a nursing home, these FPLs do NOT play a role in eligibility. Nor do they play a role in qualification for Medicare health insurance coverage, as Medicare is an entitlement program and is not based on income guidelines, income limits, household income or even gross income.

For long term care vendor Medicaid in a nursing home setting, these income levels are irrelevant. When a nursing home resident qualifies for Medicaid, all of their gross income is due to the nursing home each month, with Medicaid providing the payment for the remainder of the care costs. So income plays a role in benefit levels, but it does not come into play with respect to eligibility.

But these FPL statistics DO come into play for nearly every other Medicaid program, including SNAP, programs for other basic needs, food insecurity, affordable housing, rental assistance, tax credits, child care, healthcare for those with disabilities, energy assistance, etc.

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