(a) The
determination of monthly income and household size is dependent on the period
for which assistance is being requested and the circumstances involved.
(1) The following methods shall be used when
determining current income:
(A) For a month
prior to the current month, the actual income received within that month shall
be considered income for that month.
(B) For the current month, income already
received and any income anticipated to be received within the current month,
shall be considered income for that month.
(2) The following methods shall be used when
determining future income:
(A) To account for
future changes in income that can be reasonably anticipated, projected income
shall be calculated by one of the following methods:
(i) Current weekly income multiplied by
4.3333 to convert to monthly income;
(ii) Current bi-weekly income multiplied by
2.1667 to convert to monthly income;
(iii) When no significant fluctuation is
anticipated, the income received in the month immediately prior to the current
month can be used for the projection; or
(iv) If there has been fluctuation, an
average of the three months income immediately preceding the current month may
be utilized.
(B) Actual
changes in income and circumstances, as required to be reported by the
household, including deviations from reasonably anticipated fluctuations in
income, shall be acted upon by the department.
(b) The department shall determine the
current and future household monthly income or the projected annual household
income and household size for an applicant or beneficiary. The department shall
adopt a reasonable percentage for an increase or decrease in income, and take
into account verifying financial information with the Income Eligibility
Verification System (IEVS) data and whether the IEVS income causes the total
combined countable household income (IEVS income plus all previously reported
income) to be above or below the medical assistance standard for the
appropriate household size as described in chapter 17-1714.1:
(1) The department shall continue to use the
self-attested income amount when:
(A) The
IEVS income amount is below or at ten per cent of the self-attested income
amount, even if the total combined countable household's income exceeds the
medical assistance income standard for the applicable household size;
or
(B) The IEVS income is above ten
percent of the self-attested amount but the total combined countable
household's income remains at or below the medical assistance standard;
or
(2) The department
shall request for additional information from the household when the IEVS
income differs more than ten per cent of the self-attested income amount. A
change in the total combined countable household income requires the household
to be redetermined under the appropriate category and medical assistance
standard for the applicable household size. The department shall redetermine
household's eligibility based on the verified income amount; unless a
reasonable explanation, and if necessary, appropriate documentation, are
provided.
(c) If a
household's MAGI-based income is above the applicable medical assistance income
standard for a household of applicable size, but the household's income does
not exceed one hundred per cent of the federal poverty level for advance
payments of the premium tax credits (APTC) eligibility, MAGI as defined in
chapter 17-1700.1, which the Exchange employs, shall apply. Differences in
methodologies between medical assistance and APTC include, but are not limited
to, treatment of certain types of income, annualizing income, and household
composition.
