Page 9

MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL D-150.2 MAGI Discrepancy with Supported State-Based Marketplace Applications (42 CFR 435.603(h)(3)(i)) Applications for Medicaid received through the Exchange are sent to the state when the applicant’s stated annual income is determined to be below 100 percent of the FPL. This type of income is attested income provided by the applicant to the Exchange and may or may not be verified. The information is populated on the application as verified income and the Exchange will attempt to match this information with approved electronic data sources via the Exchange datalink with the Federal data services hub (FHUB). However, the application does not reflect whether or not the attested information was verified. If an individual is determined to be ineligible for Medicaid due to current monthly income budgeting and the application for the individual was received from the Exchange stating that the income is below 100 percent FPL, Medicaid financial eligibility will be determined in accordance with the annual income budgeting method (See MAM E-135 Application of Modified Adjusted Gross Income). Income used by the Exchange must be reasonably compatible to the current MAGI monthly income as verified by the Division. If a discrepancy between the Exchange’s stated annual income and the current of MAGI monthly income are not reasonably compatible or the difference explainable, additional verification of the stated annual income will be needed before an eligibility determination can be made. Example: It is reported on the Exchange application that the customer expects to make $22,000 this year. MAGI budgeting shows excess income of $2,500/month or $30,000 annually. The $8,000 discrepancy between the Exchange and MAGI must be verified. The customer will need to provide additional verification to explain the difference in income. Verifications may include (not all inclusive): 1. Copy of seasonal work contract 2. Migrant farmer contract 3. Statement from Employer D-155 PENDING INFORMATION Give the applicant an Insufficient Information Form, detailing what verifications are needed, allowing the household at least 10 days to provide requested verifications. When the due date falls on a weekend or holiday, the due date is the next working day. A copy of the Insufficient Information Form must be stored in the case file with the current application, reflecting the verification request due date. D-150.2 MAGI APPLICATION PROCESSING MAGI DISCREPANCY WITH SUPPORTED STATE-BASED MARKETPLACE APPLICATIONS Division of Social Servi ces Medical Assistance Man ual 25 July MTL 07/25