Updated Medicaid and CHIP Eligibility Thresholds Released

By Martha Heberlein

CMS released new MAGI-based eligibility thresholds effective April 1, and plans to release updated eligibility thresholds once a quarter. The idea is to confirm with the states that the FFM is using the correct threshold for assessing/determining eligibility in the states. So each quarter, they’re surveying the states as to what they want to report (and verifying, of course, that they have submitted a SPA and that they aren’t violating the stability protections for kids).

The April update included a number of (mostly small) changes – for example, the thresholds are now based on the 2014 federal poverty level.  Also, some states have continued to work with CMS to refine their MAGI converted thresholds to align eligibility across groups (such as in Delaware where eligibility for infants and pregnant women now align with the upper threshold in CHIP). Finally, they reflect any policy changes the states have made in terms of eligibility. Specifically, Louisiana, as we noted in our interim survey on Medicaid and CHIP under the ACA, rolled back eligibility for pregnant women from 214% to 138% of the FPL.

Our partners on the survey, the Kaiser Commission on Medicaid and the Uninsured, have done the work of converting these thresholds into a consistent family size for parents, as well as factoring in the 5 percentage point of the FPL disregard. Be sure to take a look to see if eligibility has changed in your state.

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