CHA News Article

Federal Poverty Guidelines for 2016 Released

The Centers for Medicare & Medicaid Services (CMS) has released the attached informational bulletin, which updates the poverty guidelines applied to eligibility criteria for programs such as Medicaid and the Children’s Health Insurance Program (CHIP). The bulletin also includes the new standards (also available on for the Medicare Savings Program categories. Hospitals are reminded that they must limit charges for patients who are at or below 350 percent of the federal poverty level and should update their charity care and discount payment policies to reflect the new amounts.

For a family or household of four persons living in one of the 48 contiguous states or the District of Columbia, the 2016 poverty guideline is $24,300. Separate poverty guideline figures are developed for Alaska and Hawaii, and different guidelines may apply to the U.S. territories.

To determine eligibility for Medicaid, CHIP and advance payments of the premium tax credit (APTC) and cost-sharing reductions (CSR) for the purchase of health coverage through the marketplace, states and the federal government generally use a percentage multiple of the guidelines (for example, 133 percent or 185 percent of the guidelines). The federally-facilitated marketplace will begin using the 2016 guidelines for Medicaid and CHIP eligibility on March 4. In accordance with section 36B of the Internal Revenue Code, eligibility for APTC and CSR will continue to be determined using 2015 guidelines for APTC and CSR for enrollment that is effective in 2016.