What measure of income is used by HHS to determine eligibility for Medicaid, CHIP, and the cost of premiums for health insurance purchased through health exchanges?

• A. MCOs
• B. FPL
• C. Federal Poverty Level
• D. Dual Eligibles

Answer: (C)

The measure used is the Federal Poverty Level. The Federal Poverty Level is a thresholds-based standard published by HHS that defines poverty for a given family size and is used to gauge eligibility and subsidies. Many Medicaid populations and CHIP approvals are expressed as a percentage of the FPL, with different states setting their thresholds within those ranges. For health insurance purchased through exchanges, the amount of premium subsidies is tied to income as a percentage of the FPL, with subsidies available to those within roughly 100% to 400% of the FPL. MCOs are just types of health plans and aren’t an income measure, while Dual Eligibles refer to people who qualify for both Medicare and Medicaid, not a way to determine eligibility based on income.