loading…
loading…
loading…
2. Information is not obtainable timely even with your assistance. In this situation, continue to attempt to obtain the verification. Once the verification is received, benefits may need to be adjusted based on the verified information. Note Accept a member’s or suspended member’s statement and do not require verification of income earned by an inmate from a prison or jail job that pays less than minimum wage, such as jobs through Badger State Industries (BSI). See SECTION 15.5.18 PRISON OR JAIL JOB. 20.3.8.1 Reasonable Compatibility for Income for Health Care This section addresses reasonable compatibility for income. Reasonable compatibility for assets can be found in SECTION 20.3.5.2 REASONABLE COMPATIBILITY FOR ASSETS. 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 15.5.18 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). Unearned income (as defined in SECTION 15.4 UNEARNED INCOME) is verified as outlined in this chapter and in Process Help Chapter 19.1 Data Exchange General Information. If there is an electronic data source available to use for verifying a type of unearned income, it should be used as verification for that income. If no data source is available, the applicant or member must provide verification of the