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Health Care Finance and Administration Section: Financial Eligibility Policy Manual Number: 010.035 Chapter: Reasonable Compatibility and Verification

REASONABLE COMPATIBILITY AND VERIFICATION

Legal Authority: 42 CFR 435.948

1. Policy Statement

Eligibility determinations will be based, to the maximum extent possible, on self-attestation of income that is verified by information obtained from electronic data sources. When income information obtained through electronic data sources is reasonably compatible with an individual’s attestation, the attestation is considered verified. Attestation and data sources are reasonably compatible when the difference or discrepancy between the two sources does not impact the eligibility of the application. If information is obtained through electronic data sources is not reasonably compatible with an individual’s attestation, additional documentation may be required.

2. Reasonable Compatibility

The Affordable Care Act (ACA) requires states to accept self-attestation of income information when the individual’s attestation and information obtained through an electronic data source are reasonably compatible. The reasonable compatibility test is only applied when an individual’s attested income is below the income eligibility threshold, and information obtained through an electronic data source is above the income eligibility threshold. Table 1.1 Reasonable Compatibility Test illustrates when information is subject to the reasonable compatibility test, and when it is not.

Table 1.1 Reasonable Compatibility Test

Attested Income (including 5% disregard, if applicable) Electronic Data Source Outcome Is below the income eligibility threshold Is below the income eligibility threshold Individual is financially eligible. The reasonable compatibility test is not required. Is below the income eligibility threshold. Is above the income eligibility threshold. Income is subject to reasonable compatibility test. Is below the income eligibility threshold. Is not available Request additional verification. Is above the income eligibility threshold Is above the income eligibility threshold Individual is ineligible. The reasonable compatibility test is not required. Is above the income eligibility threshold. Is below the income eligibility threshold. Attested income is used. The individual is ineligible. The reasonable compatibility test is not required. June 4, 2015 HCFA 1