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).

The applicant or enrollee must attest to current monthly household income at application, renewal or when reporting a change.
The county, tribal or DHS servicing agency must attempt to verify attested income, adjustments and exceptions using available electronic data sources.
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.
When the attested information indicates MA-FCA eligibility, but electronic data sources are unavailable, or are reporting information that is not reasonably compatible with attestation, the agency must request paper proof from the person.
The agency must send a notice to the applicant requesting the paper proof and date the proof is due to complete the MA-FCA eligibility determination.

The agency must resolve the discrepancy before granting MA-FCA eligibility. While MA-FCA eligibility is pending, the applicant or enrollee must have an opportunity to resolve errors that prevented successful electronic verification or submit paper proof. The agency must give the applicant at least 10 days to respond to the request, or for a new application until the end of the 45-day application processing period, whichever is later.
The person must provide acceptable proof within 10 days of the request by the agency. MA-FCA eligibility for enrollees cooperating and attempting to obtain verification is not denied or closed, except for when proofs are required to complete a renewal.
The county, tribal or state servicing agency must assist clients in obtaining verification.
An applicant who fails to respond to a request for paper proof is not eligible for MA-FCA. The effective date of the denial is the day after the proof was due.

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, and the electronic data indicates income above the MA income limit. Inconsistent information about income at application must be resolved before MA is approved. See 1.3.2.4 MHCP Inconsistent Information for the full policy.

Paper Proof that Clarifies Income, Adjustments and Exceptions

Applicants may correct or revise their attested information during the application process. A request for information or paper proof submitted by the applicant may provide additional sources of income the applicant forgot to report, or revisions to the amount of income reported from a source. Information received from the applicant while MA-FCA is pending, including income amounts from paper proof that clarify the applicant’s current income, must be used in the initial eligibility determination. This information is considered a correction to the applicant’s attested income.

An applicant may report a change in circumstances, such as income, while MA-FCA eligibility is pending. When an applicant reports a change that occurred after the date of application, the new information does not impact the initial eligibility determination. The agency must determine eligibility using the original verified information for the month of application and any retroactive months requested. Then, the agency must redetermine eligibility based on the new information received from the applicant, according to standard policies about changes in circumstances.

Proof Received After Denial

When an applicant provides paper proof after the effective date of denial, the submission is considered a new request for coverage. Standard application and begin date policies and procedures apply based on the date the agency received the proof. See 2.1.4.1 MA Begin and End Dates for the full policy.

A new application may not be needed if the person is currently eligible for another insurance affordability program (including unassisted qualified health plan) or is a household member on an open case with other eligible people. The agency must verify current income before MA-FCA eligibility can be determined. A new application may be required if there is no one on the case eligible for an insurance affordability program. Reapplications or redeterminations may result in new paper proofs needed.

Paper Proof

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
Statement from the bank or other financial institution
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 to income that appear on line 10 on IRS Form 1040 or on Schedule 1 (Form 1040) 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: