56.03 Verification process for APTC and CSR – general procedures

An individual must be eligible for APTC and have household income at or below 300% of the FPL in order for the individual to be eligible for the Vermont Premium Reduction and Vermont CSR. To receive the federal and Vermont CSR, an individual who is not an Indian must be enrolled in a silver-level QHP. In determining eligibility for APTC and CSR: Family size45 The individual must attest to the persons that comprise a tax filer’s family size. To the extent that the individual attests that the tax data described in § 56.01(a) represent an accurate projection of a tax filer’s family size for the benefit year for which coverage is requested, the individual’s attestation will be accepted without further verification. To the extent that tax data are unavailable, or the individual attests that a change in circumstances has occurred or is reasonably expected to occur, and so they do not represent an accurate projection of a tax filer’s family size for the benefit year for which coverage is requested, the tax filer’s family size will be verified by accepting the individual’s attestation without further verification, except as specified in paragraph (a)(4) of this subsection. If the individual’s attestation to a tax filer’s family size is not reasonably compatible, as that term is defined in § 57.00(a)(1), with other information provided by the individual or in AHS’s records, data obtained through other electronic data sources will be used to verify the attestation. If such data sources are unavailable or information in such data sources is not reasonably compatible with the individual’s attestation, additional documentation will be requested to support the attestation within the procedures specified in § 57.00. Verification regarding APTC and CSR. AHS will verify that neither APTC nor CSR is being provided on behalf of an individual by using information obtained by transmitting identifying information specified by HHS to HHS.46 (b) Basic verification process for annual household income47 45 45 CFR § 155.320(c)(3)(i). 46 45 CFR § 155.320. 47 45 CFR § 155.320(c)(3)(ii). Eligibility-and-Enrollment Procedures Part 7 – Page 21 (Sec.56.00, Sub.56.04) The individual must attest to the tax filer’s projected annual household income. AHS will compute annual household income based on the tax data described in § 56.01(a) (tax-based income calculation), if available. To the extent that the individual’s attestation indicates that the tax-based income calculation under paragraph (b)(2) of this subsection represents an accurate projection of the tax filer’s household income for the benefit year for which coverage is requested, the tax filer’s eligibility for APTC and CSR will be determined based on that calculation. To the extent the tax data described in § 56.01(a) are unavailable or the individual attests that a change in circumstances has occurred or is reasonably expected to occur, and so they do not represent an accurate projection of the tax filer’s household income for the benefit year for which coverage is requested, AHS will require the individual to attest to the tax filer’s projected household income for the benefit year for which coverage is requested. (c) Verification process for increases in household income Except as specified in paragraphs (c)(2) or (3) of this subsection, the individual’s attestation for the tax filer’s household will be accepted without further verification if: (i) The individual attests that the tax filer’s annual household income has increased or is reasonably expected to increase from the tax-based income calculation under paragraph (b)(2) of this subsection; and (ii) AHS has not verified the individual’s income through the process specified in § 56.02(b) to be within the applicable Medicaid income standard. If the non-tax data available to AHS, as described in § 56.01(b), indicate that a tax filer’s projected annual income is in excess of their attestation by more than twenty-five percent, AHS will proceed in accordance with § 57.00(c)(1)-(4)(i). If other information provided by the individual indicates that a tax filer’s projected annual household income is in excess of the individual’s attestation by more than twenty-five percent, the non-tax data will be used to verify the attestation. If such data are unavailable or information in such data is not reasonably compatible with the individual’s attestation, AHS will proceed in accordance with § 57.00(c)(1)-(4)(i).