Medical Assistance for Families with Children and Adults

2.2.3.5 Income Verification

All countable income must be verified for Medical Assistance for Families with Children and Adults (MA-FCA).

  1. The applicant or enrollee must attest to current monthly household income at application, renewal or when reporting a change.

  2. The applicant or enrollee’s attested income, adjustments and exceptions are verified using available electronic sources.

  3. Income is considered verified if:

    • The attested income and the electronic data both indicate income is below the applicable MA income limit or

    • The attested income is at or below the MA income limit and the electronic data indicates income above the MA limit, but they are reasonably compatible.

  4. If the information cannot be verified by available electronic sources, the person must provide acceptable proof within 10 days of the request by the county, tribal or state servicing agency. Acceptable proof is paper proof.

  5. The county, tribal or state servicing agency must assist clients in obtaining verification. When neither the person nor the county, tribal or state servicing are able to obtain outside verification, a reasonable explanation of the discrepancy may be accepted in circumstances where paper proof is not available such as when the source of income has stopped.

MA-FCA eligibility for enrollees cooperating and attempting to obtain verification is not closed, except for when proofs are required to complete a renewal.

An individual who reports having no income is not required to provide verification or an explanation, unless electronic sources or other information the agency has indicate there is inconsistent information. At application, information from electronic data sources that indicate a person has a source of income, such as wages from a job, is inconsistent information when the person has reported no income from that source. Inconsistent information about income at application must be resolved before MA is approved. See EPM 1.3.2.4 MHCP Inconsistent Information for the full policy.

Income

A wide variety of paper documentation is acceptable proof of financial eligibility. Common proof includes, but is not limited to, the following:

  • Pay stub or earnings statement

  • Employer statement

  • Tax records

  • Copy of check

  • Business financial records

  • Bank statement

  • Interest or dividend statement

  • Award letter

  • Proof of alimony

  • Receipt or statement of rent you receive

  • Proof of asset sale (Capital Gain or Loss)

  • Proof or record of other taxable income

  • Proof of lump sum income

  • Other proof

Federal Income Tax Adjustments

Adjustments that appear on lines 23 through 35 on IRS Form 1040 or lines 16 through 19 on the IRS Form 1040-A are subtracted from gross taxable income to calculate the adjusted gross income. Only these specific types of adjustment are allowable. A copy of the last filed IRS Form 1040 or 1040A is acceptable verification for adjustments.

Applicants and enrollees who expect to have these adjustments for the current tax year can complete the appropriate form or worksheet listed below to determine the adjustment amount. These adjustments are a calculated or limited amount and the listed proof allows applicants to report anticipated adjustment accurately.

A wide variety of paper documentation is acceptable proof of financial eligibility. Common proof includes, but is not limited to, the following:

Educator expenses

  • Copy of last filed IRS Form 1040 with this adjustment listed on line 23

  • Copy of last filed IRS Form 1040A with this adjustment listed on line 16

Anticipated adjustment for the current tax year

  • Self-attestation of a maximum of $250 for one educators or $500 if both spouses are educators

Certain business expenses of reservists, performing artists and fee-basis government officials

  • Copy of last filed IRS form 1040 with this adjustment listed on line 24

Anticipated adjustment for the current tax year

  • Copy of IRS Form 2106 or 2106 EZ

Health savings account

  • Copy of last filed IRS Form 1040 with this adjustment listed on line 25

Anticipated adjustment for the current tax year

  • Copy of IRS Form 8889

Moving expenses

  • Copy of last filed IRS Form 1040 with this adjustments listed on line 26

Anticipated adjustment for the current tax year

  • Copy of IRS Form 3903

Adjustment portion of self-employment tax

  • Copy of last filed IRS Form 1040 with this adjustment listed on line 27

Anticipated adjustment for the current tax year

  • Copy of IRS Schedule SE

Self-employed Simplified Employee Pension (SEP), Savings Incentive Match Plan for Employees (SIMPLE) and Qualified Plans

  • Copy of last filed IRS Form 1040 with this adjustment listed on line 28

Anticipated adjustment for the current tax year

  • Copy of adjustment worksheets from IRS Publication 560 (pages 22-24 of the 2012 publication)

Self-employed Health Insurance

  • Copy of last filed IRS Form 1040 with this adjustment listed on line 29

Anticipated adjustment for the current tax year

  • Copy of the “Self-Employed Health Insurance Worksheet” for line 29 of IRS Form 1040 (page 31 of the 2013 IRS 1040 Instructions)

Penalty on Early Withdrawal of Savings

  • Copy of last filed IRS Form 1040 with this adjustment listed on line 30

Anticipated adjustment for the current tax year

  • Copy of 1099-INT or Form 1099-OID received from the institution, which shows the amount of penalty

Alimony Paid (spousal support)

  • Copy of last filed IRS Form 1040 with this adjustment listed on line 31

Anticipated adjustment for the current tax year

  • Copy of court order, divorce or separation instrument indicating amount of spousal support

IRA Deduction

  • Copy of last filed IRS Form 1040 with this adjustment listed on line 32

  • Copy of last filed IRS Form 1040A with this adjustment listed on line 17

Anticipated adjustment for the current tax year

  • Copy of IRA Deduction Worksheet, pages 34 and 35 of the 2013 IRS 1040 Instructions

  • Copy of IRA Deduction Worksheet, pages 30 and 31 of the 2013 IRS 1040A Instructions

Student Loan Interest

  • Copy of last filed IRS Form 1040 with this adjustment listed on line 33

  • Copy of last filed IRS Form 1040A with this adjustment listed on line 18

Anticipated adjustment for the current tax year

  • Copy of Student Loan Interest Deduction Worksheet, page 36 of the 2013 IRS 1040 Instructions

  • Copy of Student Loan Interest Deduction Worksheet, page 32 of the 2013 1040A instructions

Tuition and Fees

  • Copy of last filed IRS Form 1040 with this adjustment listed on line 34

  • Copy of last filed IRS Form 1040A with this adjustment listed on line 19

Anticipated adjustment for the current tax year

  • Copy of IRS Form 8917

Domestic Production Activities

  • Copy of last filed IRS Form 1040 with this adjustment listed on line 35

Anticipated adjustment for the current tax year

  • Copy of IRS Form 8903

Other Income Proofs

A wide variety of documentation proof is acceptable proof of financial eligibility. Common proof includes, but is not limited to, the following:

Nontaxable foreign earned income and housing cost of citizens or residents of the United States living abroad

  • Tax records

  • Income statement

Nontaxable interest income

  • Tax records

  • Bank statement

Nontaxable Social Security and tier one railroad retirement benefits

  • Benefit statement

  • Award letter

  • SSA/RRB Form 1099

Scholarships, awards or fellowship grants used for education purposes and not for living expenses

  • Proof of scholarship or grant for education purposes

  • Student loan statement

Certain American Indian/Alaska Native income

  • Proof of American Indian or Alaska Native income

Lump Sum income

  • Proof of lump sum income

When neither the person nor the county, tribal or state servicing are able to obtain outside verification, a reasonable explanation of the discrepancy may be accepted in circumstances where paper proof is not available such as when the source of income has stopped.

Legal Citations

Code of Federal Regulations, title 42, section 435.945

Code of Federal Regulations, title 42, section 435.948

Code of Federal Regulations, title 42, section 435.952

Minnesota Rules, part 9505.0095