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Equal to or below the MAPP premium threshold (100% of the FPL) Equal to or below the MAPP premium threshold (100% of the FPL) Yes. Eligibility will be based on the member-reported earnings amount, and a premium will not be owed. Equal to or below the MAPP premium threshold (100% of the FPL) Above the MAPP premium threshold (100% of the FPL) The 20% threshold test occurs. • If the total gross income using the monthly earnings reported by SWICA or Equifax is equal to or less than 120% of the total gross income using the monthly earnings amount reported by the member, the amounts are reasonably compatible. Eligibility will be based on the member-reported earnings amount, and a premium will not be owed. • If the total gross income using the monthly earnings reported by SWICA or Equifax is greater than 120 % of the total gross income using the monthly earnings amount reported by the member, the amounts are not reasonably compatible. Further verification must be requested. Above the MAPP premium threshold (100% of the FPL) Above the MAPP premium threshold (100% of the FPL) A reasonable compatibility test was not done. Income must be verified for the correct premium amount to be determined. Above the MAPP premium threshold (100% of the FPL) Equal to or below the MAPP premium threshold (100% of the FPL) A reasonable compatibility test was not done. Income must be verified for the correct premium amount to be determined. Because different thresholds are used for different populations, individual members of a household or a given AG may pass the reasonable compatibility test while others do not. Example 4 Leonard is applying for EBD Medicaid. He is not married and has no children. The SSI-Related Medically Needy monthly income limit is $1,330. Leonard reports monthly earned income of $1,200; this is his only income, and it is below the income limit. The State Wage Information Collection Agency (SWICA) reports that Leonard’s monthly earned income is $1,400. This income amount is above the income limit. Therefore, the reasonable compatibility test using the 20% threshold will be applied.

The 20% threshold amount is the amount that is 20% greater than the total income that includes the earned income reported by the applicant or member. In this example, the 20% threshold amount is $1,440. The total income that includes the earned income reported by SWICA ($1,400) is less than the 20% threshold amount ($1,440). Therefore, the amounts are determined to be reasonably compatible. Leonard does not need to verify the earned income. 20.3.8.1.3 Reasonable Compatibility Test Reasonable compatibility will first be tested based on the household’s total countable income as reported to the agency or verified through other sources. This test will determine whether the member is required to provide verification of earnings.