Income Eligibility for HPE Determination Sites Last updated 2/15/2024
Quick Guide to Income Eligibility (effective March 1, 2024)
Hospitals - Refer to the following table when making Hospital Presumptive Eligibility determinations based on
the information required in Part 1 of the OHP 7260 form.
◼ Determine the family size for each applicant.
◼ Count the monthly gross income (before taxes) of everyone included in the family size for the specific
program.
◼ If the applicant’s income is equal to or under the income limit for a program, the applicant is considered
financially eligible for that program.
◼ Only calculate HPE eligibility based on monthly income. Do not consider annual income amounts.
NOTE: Income standards for HPE are not the same as the income standards for regular OHP eligibility. The
5% disregard is not added, and other distinctions may apply as well. Please use this table exclusively for
Hospital Presumptive Eligibility determinations.
Group/Description
Family Size
Income
Limit
Do not count
Parent or Other Caretaker Relative
• Parents or caretaker relatives of dependent
children in the home under age 18 or age 18 and in
high school
• Family size includes:
o Applicant
o Legal spouse of applicant
o Applicant’s children/step-children under
age 19
o Applicant’s unborn children
o Unborn children of each pregnant member
of the applicant’s family size
1
$399
Child(ren)’s income
Educational income
Child support
SSI
2
515
3
611
4
747
5
872
6
998
7
1,114
8
1,230
9
1,321
10
1,456
Each additional
person
+136
Adults and Medicaid Children Ages 1-18
• Adults age 19 through 64
• Children age 1 through 18
• Not pregnant
• Not eligible for Parent/Caretaker Relative
• Income limit is 133% of Federal Poverty Level
(FPL)
• Family size includes:
o Applicant
o Legal spouse of applicant
o Applicant’s children/step-children under
age 19
o Unborn children of each pregnant member
of the applicant’s family size
o If applicant is a child, include the child’s
parents/step-parents and siblings/step-
siblings under age 19
1
$1,670
Child(ren)’s income
Parent’s income (if
applicant is over age
18)
Educational income
Child support
SSI
2
2,266
3
2,862
4
3,458
5
4,055
6
4,651
7
5,247
8
5,844
9
6,440
10
7,036
Each additional
person
+597
Pregnant Woman and Medicaid Children Under 1
• Women under age 65 who are pregnant
• Children under age 1
• Income limit is 185% of FPL
• Family size includes:
o Applicant
o Legal spouse of applicant
o Applicant’s unborn children
1
$2,322
Child(ren)’s income
Parent’s income (if
applicant is over age
18)
Educational income
Child support
2
3,152
3
3,981
4
4,810
5
5,640
6
6,469
7
7,299
8
8,128
HEALTH SYSTEMS DIVISION
Hospital Presumptive Eligibility Process
Income Eligibility for HPE Determination Sites Last updated 2/15/2024
o Applicant’s children/step-children under
age 19
o Unborn children of each pregnant member
of the applicant’s family size
o If applicant is a child, the child’s
parents/step-parents and siblings/step-
siblings under age 19
9
8,958
SSI
10
9,787
Each additional
person
+830
Former Foster Care Youth
• Aged out of foster care in any state on or after their
18th birthday
• Was in foster care with a PERC 19 on their 18th
birthday
• Not eligible for any of the programs listed above
excluding Medicaid Adult – Screen for Former
Foster Care Youth before Medicaid Adult, BCCTP,
and CHIP
• Age 18 through 25
• Adoptions Assistance individuals (PERC 19) and
foster care individuals with a PERC “GA” should
not be approved for this program.
1
No income
limit
Do not count any
income for this
program.
Breast and Cervical Cancer Treatment Program
(BCCTP)
• Less than 65 years old
• Diagnosed as needing treatment for breast or
cervical cancer or specific precancerous conditions
• Not eligible for any of the programs listed above
• Income limit is 250% of FPL
• Family size includes:
o Applicant
o Legal spouse of applicant
o Applicant’s children/step-children under
age 19
o Unborn children of each pregnant member
of the applicant’s family size
o If applicant is a child, include the child’s
parents/step-parents and siblings/step-
siblings under age 19
1
$3,138
Child(ren)’s income
Educational income
Child support
SSI
2
4,259
3
5,380
4
6,500
5
7,621
6
8,742
7
9,863
8
10,984
Each additional
person
+1121
CHIP Children
• Age 0 through 18
• Not eligible for any of the programs listed above
• Income limit is 300% of FPL
• Family size includes:
o Applicant
o Legal spouse of applicant
o Applicant’s unborn children
o Applicant’s children and step-children
o Unborn children of each pregnant member
of the applicant’s family size
o Applicant’s parents/step-parents
o Siblings and step-siblings under age 19
1
$3,765
Child(ren)’s income
Educational income
Child support
SSI
2
5,110
3
6,455
4
7,800
5
9,145
6
10,490
7
11,835
8
13,180
9
14,525
10
15,870
Each additional
person
+1,345
