Federal Poverty Guidelines 2023 Release and the “Unwinding” of Medicaid Continuous Enrollment Period

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 2023 Poverty Guidelines are effective January 16, 2023, and are now posted HERE.

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. To view frequently asked questions related to the federal poverty guidelines and poverty, click HERE.

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 $30,000. We would multiply $30,000 times 1.38 to obtain the income limit equal to 138 percent ($41,400).

2023 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA

 

PERSONS IN FAMILY/HOUSEHOLD	POVERTY GUIDELINE
1	$14,580
2	$19,720
3	$24,860
4	$30,000
5	$35,140
6	$40,280
7	$45,420
8	$50,560
For families/households with more than 8 persons, add $5,140 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 Thursday, December 29, 2022, the Consolidated Appropriations Act, 2023 (CAA, 2023) was enacted. This law includes various Medicaid and Children’s Health Insurance Program (CHIP) provisions, including significant changes to the continuous enrollment condition of the Families First Coronavirus Response Act (FFCRA) that take effect April 1, 2023. Under this section of the FFCRA, states claiming a temporary 6.2 percentage point increase in the Federal Medical Assistance Percentage (FMAP) have been unable to terminate enrollment for most individuals enrolled in Medicaid as of March 18, 2020, as a condition of receiving the temporary FMAP increase. When this continuous enrollment condition ends, states must, over time, return to normal eligibility and enrollment operations. This process has commonly been referred to as “unwinding”. The newly enacted CAA, 2023 does not address the end date of the COVID-19 Public Health Emergency (PHE), and as of January 2023, the PHE is still in effect; it does, however, address the end of the continuous enrollment condition, the temporary FMAP increase, and the unwinding process. Additional information can be found at https://www.medicaid.gov/federal-policy-guidance/downloads/cib010523.

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 beginning April 1, 2023.

 

Betsy Moore
Vice President, Operations
Centauri Health Solutions, Inc.