Page 14
Medicaid Reasonable Compatibility Standards for Income Attestation and Data Scenario Reasonable Compatibility Standard Attestation and income data from external sources are above applicant’s Medicaid eligibility levels. Reasonably Compatible: Person ineligible for Medicaid; eligibility for a qualified health plan (QHP) is determined The attestation is below the applicant’s Medicaid eligibility level and the income data from external sources are above the applicant’s Medicaid eligibility level, and the difference between the attestation and data is ten percent (10%) or less. Reasonably Compatible: Person eligible for Medicaid The attestation is below the applicant’s Medicaid eligibility level and the income data from external sources are above the applicant’s Medicaid eligibility level, and the difference between the attestation and data is greater than ten percent (10%). Not Reasonably Compatible: pursue discrepancy reconciliation. Person may provide a reasonable explanation and/or provide the State with documentation of current income. 1. Income attestation and data are both below Medicaid eligibility levels – Attestation and data sources are reasonably compatible if the difference or discrepancy between the two (2) does not affect the eligibility of the applicant. In other words, even if there is a difference between what an applicant says he or she earned and what the data shows was actually earned, the attestation and data are considered reasonably compatible if both are below Medicaid eligibility levels. 2. Attestation and data are both above Medicaid eligibility levels – Attestation and data sources are reasonably compatible if they are both above the Medicaid eligibility levels. Under such a scenario, the person would be found ineligible for Medicaid. For example, this would occur if an applicant attests to income above the eligibility ceiling for the applicable MACC