300% of Poverty Guidelines
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Defines eligibility for services based on recipient household income at or below 300% of the federal poverty level and explains household composition for determining income thresholds.
No material clinical or coverage changes in this revision.
Income-based Eligibility
Income-based eligibility criteria
Covered when ALL of the following are met:
Income Threshold Tables
| 1 | $15,960 |
| 2 | $21,640 |
| 3 | $27,320 |
| 4 | $33,000 |
| 5 | $38,680 |
| 6 | $44,360 |
| 7 | $50,040 |
| 1,2 | $21,227 (example entry) |
| 1,3 | $22,025 |
| 1,4 | $23,940 |
| 1,5 | $31,920 |
| 1,6 | $47,880 |
| 1,7 | $63,840 |
| 2,2 | $28,781 |
| 2,3 | $29,863 |
| 2,4 | $32,460 |
| 2,5 | $43,280 |
| 2,6 | $64,920 |
| 2,7 | $86,560 |
| 3,2 | $36,336 |
| 3,3 | $37,702 |
| 3,4 | $40,980 |
| 3,5 | $54,640 |
| 3,6 | $81,960 |
| 3,7 | $109,280 |
| 4,2 | $43,890 |
| 4,3 | $45,540 |
| 4,4 | $49,500 |
| 4,5 | $66,000 |
| 4,6 | $99,000 |
| 4,7 | $132,000 |
| 5,2 | $51,444 |
| 5,3 | $53,378 |
| 5,4 | $58,020 |
| 5,5 | $77,360 |
| 5,6 | $116,040 |
| 5,7 | $154,720 |
| 6,2 | $58,999 |
| 6,3 | $61,217 |
| 6,4 | $66,540 |
| 6,5 | $88,720 |
| 6,6 | $133,080 |
| 6,7 | $177,440 |
| 1 | $1,330 |
| 2 | $1,803 |
| 3 | $2,277 |
| 4 | $2,750 |
| 5 | $3,223 |
| 6 | $3,697 |
| 7 | $4,170 |
| 1,2 | $1,769 |
| 1,3 | $1,835 |
| 1,4 | $1,995 |
| 1,5 | $2,660 |
| 1,6 | $3,990 |
| 1,7 | $5,320 |
| 2,2 | $2,398 |
| 2,3 | $2,489 |
| 2,4 | $2,705 |
| 2,5 | $3,607 |
| 2,6 | $5,410 |
| 2,7 | $7,213 |
| 3,2 | $3,028 |
| 3,3 | $3,142 |
| 3,4 | $3,415 |
| 3,5 | $4,553 |
| 3,6 | $6,830 |
| 3,7 | $9,107 |
| 4,2 | $3,658 |
| 4,3 | $3,795 |
| 4,4 | $4,125 |
| 4,5 | $5,500 |
| 4,6 | $8,250 |
| 4,7 | $11,000 |
| 5,2 | $4,287 |
| 5,3 | $4,448 |
| 5,4 | $4,835 |
| 5,5 | $6,447 |
| 5,6 | $9,670 |
| 5,7 | $12,893 |
| 6,2 | $4,917 |
| 6,3 | $5,101 |
| 6,4 | $5,545 |
| 6,5 | $7,393 |
| 6,6 | $11,090 |
| 6,7 | $14,787 |
Actionable Eligibility Summary
Eligibility: income ≤ 300% FPL — provider verification steps
Recipients whose household income is less than or equal to 300% of the federal poverty level qualify for services. Providers must determine eligibility by comparing the member’s household income to the 300% FPL thresholds (use the policy’s annual or monthly threshold tables by household size to find the numeric cutoff).
- Verify household membership per IRS tax guidelines when calculating household income.
- Use the document’s 300% FPL tables (annual or monthly) for the member’s household size to determine the numeric eligibility threshold.
- Document the income basis (annual or monthly) and household size used in the eligibility determination in the member’s record.
Household Definition
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