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Note Eligibility cannot be denied or terminated for failure to verify information that the member is not responsible to obtain, such as employer-sponsored health insurance (see SECTION 9.9.7 VERIFICATION OF EMPLOYER- SPONSORED HEALTH INSURANCE), Child Welfare parent cooperation (see SECTION 10.1 ELIGIBILITY FOR PARENT OR CARETAKER RELATIVE OF CHILD REMOVED FROM HOME), and former Foster Care status (see SECTION 11.2 FORMER FOSTER CARE YOUTH). Eligibility cannot be denied or terminated for failure to verify medical expenses (see SECTION 9.9.4 MEDICAL EXPENSES) and deductions (see SECTION 9.9.9 PRETAX DEDUCTIONS and SECTION 9.9.10 MAGI TAX DEDUCTIONS). The disallowance of unverified expenses and deductions is the only penalty to be imposed. Eligibility cannot be denied or terminated for failure to verify tribal member status (see SECTION 9.9.8 TRIBAL MEMBERSHIP, DESCENT, OR ELIGIBLE TO RECEIVE INDIAN HEALTH SERVICES) This page last updated in Release Number: 26-02 Release Date: 04/15/2026 Effective Date: 04/15/2026 9.12 Reasonable Compatibility for Health Care Agencies may not request verification from health care applicants and members unless the information cannot be obtained through an electronic data source, the income is jail or prison earnings of an inmate (see SECTION 9.9.6.1 PRISON OR JAIL JOB), or information from the data source is not “reasonably compatible” with what the applicant has reported. Information from a data source that supports an eligibility determination based on the attested information provided by an applicant or member is considered “reasonably compatible.” The following list describes the potential scenarios and whether the scenario results in a determination of reasonable compatibility: • If both the electronic data source and the member-reported information put the individual’s total countable income below a given income threshold, the two data sources are considered to be reasonably compatible, and further verification may not be requested or required. • If the electronic data source puts the individual’s total countable income above a given income threshold, but the member-reported information puts the individual’s total countable income below that same threshold, an additional test that uses a 20% threshold occurs. ◦ If the individual’s total countable income using information from the electronic data source is less than or equal to 120% of the individual’s total countable income using the member-reported information, the two data sources are considered to be reasonably compatible, and further verification may not be requested or required. ◦ If the individual’s total countable income using information from the electronic data source is more than 120% of the individual’s total countable income using the member- reported information, the two data sources are not reasonably compatible and further verification is required as a condition of eligibility. • If the member reports income that is above a given threshold, the member-reported income information is used to deny or terminate health care benefits, regardless of what the outcome would be using information from the electronic data source. In this scenario, verification is not required. The reasonable compatibility test is only applied to job earnings that have not otherwise been verified (for example, as part of another program’s verification process). It can only be applied when earnings information is available through the State Wage Information Collection Agency (SWICA) or through Equifax from the Federal Data Services Hub (FDSH).