When it comes to Medicaid, there is a lot of confusion as to what it means to be eligible on a state by state basis. The assumption may be that Medicaid recipients are eligible if their income falls under 100% of the federal poverty line (FPL).This is incorrect.
What does the FPL mean? This is an annually adjusted chart that identifies the FPL levels based on household income and size. Household income is determined based on modified adjusted gross income (MAGI). Further, the actual dollar amounts are higher in Alaska and Hawaii than in the continental US.
For example, the 2017 FPL chart calls for a family of four at 100% of the FPL in Alaska to be $30,380, but in Hawaii to be $27,950. These are different from the 48 contiguous states and Washington, D.C., as the 100% of the FPL for 2017 would be a different figure, at $24,300.
For those states that have expanded Medicaid, eligibility was expanded to 138% of the FPL. However, for those states that have not expanded Medicaid, eligibility typically is at much lower levels below 100%. California, for example, a childless adult would qualify for Medicaid at 138% of the FPL, which is $16,400 for a household size of one for 2017.
Texas has far more stringent eligibility standards for Medicaid, 18% of the FPL, roughly $2,000. Eligibility changes depending on the status of the individual, such as whether the individual is a childless adult, child, pregnant and/or disabled.
So what does this mean? As we await the future of Medicaid and its expansion, one shouldn’t assume that eligibility is the same among the states. The variations in eligibility are wide-ranging.
