Page 6

MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-004

Reasonably Compatibility Scenarios The following scenarios provide examples related to reasonable compatibility with respect to income:

Scenario 1: Charles submitted an initial application for Medicaid. He is a single, parent/caretaker relative to three children. Individual self-attestation of income is below the Medicaid MAGI eligibility level and the Data match shows Charles’ income is below the Medicaid eligibility level: o Eligibility level= $1175 (monthly) o Self-attested current income= $700 o IRS data= $800 Determination: Charles is determined eligible for Medicaid because the information received from the electronic data sources and the self-attested information is all below the Medicaid eligibility level. Scenario 2: Betty submitted an initial application for Medicaid. She is a single, parent/caretaker relative to one child. Individual self-attestation of income is above the Medicaid MAGI eligibility level and the Data match shows that the Betty’s income is above the Medicaid MAGI eligibility level. o Eligibility level= $774 o Self-attested current income= $1,655 o IRS data= $1,542 Determination: The self-attested income and the information from the data sources are all above the Medicaid eligibility level, so Betty is determined ineligible for Medicaid and screened for eligibility for APTC/CSR through the Exchange. Scenario 3: Sophie submitted an initial application for her two children, Scarlett (age 3) and Ben (age 7). The children have creditable health insurance. Ben: Individual self-attestation of income is below the Medicaid MAGI eligibility level and the Data match shows that Sophie’s income is above the Medicaid MAGI eligibility level. Scarlett: Individual self-attestation of income is below the Medicaid MAGI eligibility level and the data match shows that Sophie’s income is below the Medicaid MAGI eligibility level. o Eligibility level for Scarlett= $ 2,436 o Eligibility level for Ben= $2,234 o Self-attested current income= $2,100 o IRS data= $2,250 Determination: Scarlett is determined eligible for Medicaid as the information received from the electronic data source and the self-attested information is below the Medicaid eligibility level. The reasonable compatibility standard is applied in Ben’s scenario as the self-attested income is below the Medicaid level and the data source is above the applicable income level. Ben is determined Medicaid eligible as the self-attested income and the electronic data source is at 10%.