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06/28/16

Summary

  • This release introduces the auto-REDE process for medical cases in the Integrated Eligibility System (IES) for phase 2.
  • IES phase 2 will centrally send the medical redetermination forms.
  • A three step process is used for the IES medical REDE process:  selection/exclusion criteria, a clearance check followed by REDE certification.
  • IES initiates Process A for medical cases that meet criteria for auto-REDE.
  • IES initiates Process B for medical cases that do not meet criteria for auto-REDE and require a manual REDE.
  • As a result of the new functionality offered by IES, the redetermination forms are highly dynamic based on case characteristics such as the type of assistance received and whether or not the household is subject to Modified Adjusted Gross Income (MAGI) budgeting.
  • SNAP and cash cases must always be redetermined manually regardless of the automated medical REDE process described in this release.
  • Reasonable compatibility policy is clarified and added to the manual.

  1. Auto-REDE (Process A)
  2. Manual REDE (Process B)
  3. Step 1- Medical REDE Selection Process
    1. Criteria for Medical Auto-REDE
    2. Exclusions to Medical Auto-REDE
      1. By Program and Service
      2. Special Case Conditions
  4. Step 2- Medical REDE Clearances
    1. Clearance Results
      1. Electronic Data Not Available
      2. Auto-REDE (Process A)
      3. Manual REDE (Process B)
        1. Households Receiving Medical Only
        2. Households Receiving Medical with SNAP and/or Cash
  5. Step 3- Processing the Medical REDE
    1. Auto-REDE (Process A)
      1. Responding to a Change for an Auto-REDE Case
    2. Manual REDE (Process B)
    3. Medical Household Receives SNAP and/or Cash Assistance
      1. Verified Income is Different for SNAP and/or Cash than for Medical
  6. Alignment of Certification Periods by REDE Scenario
  7. Reasonable Compatibility
  8. MANUAL REVISIONS

The Affordable Care Act requires an automated process for medical redeterminations without requiring information from the customer if verifications are available electronically. IES will determine which medical cases can be selected for auto-REDE and which ones require manual processing.

A manual REDE can be submitted by an individual using one of the 4 following methods:

  • Electronically through Manage My Case in ABE;
  • For medical: by phone at 1-800-843-6154 (TTY: 1-800-447-6404);
  • Completing the paper REDE form (for medical REDEs, this includes IL 444-1893 and new medical only REDE forms 643M, 643N, 643X); and
  • In person by visiting the office managing the individual's case.

Reminder: SNAP and cash assistance cannot be REDE'd by phone.

The new medical REDE forms are highly dynamic forms that include only relevant questions based on whether the case is budgeted using the MAGI methodology described in PM 15-06-01, budgeted using the legacy methodology described in PM 08-02-03 or is an LTC Nursing Home/SLF case. For medical households also receiving SNAP or cash assistance, the SNAP and cash assistance REDE form IL 444-1893 is programmed in IES to include additional questions required for the medical REDE. 

Auto-REDE (Process A)

Form 2381A Medical Benefits Redetermination Notice, a new medical REDE outcome approval form, is sent to medical households selected for auto-REDE. When this form is mailed, the medical REDE (from the customer's perspective) is considered complete.  If the customer has a change in circumstances, they have 30 days to report the change before IES certifies the REDE as a mass change on cutoff. If the customer does not contact the office, no further action is required for the REDE.  IES will auto-certify the medical case at cutoff.

Form 2381A is sent at the same time as Form IL 444-1893 when a household receives SNAP or cash assistance. Form IL 444-1893 must be completed and returned for the SNAP and cash manual redetermination.

Note:  SNAP and cash assistance cannot be auto-REDE'd. Reporting changes within 30 days applies to medical only.  A face to face interview is required for cash by the date specified on the REDE form 1893. A face to face or phone interview is required for SNAP by the date specified on the REDE form 1893.

Manual REDE (Process B)

Forms 2381/2381B Medical Benefits: Time to Renew, a new form used for manual REDE, is sent when the household receives medical only or medical with SNAP and cash assistance. Forms 2381/2381B instructs the customer to submit the medical REDE using one of the four methods listed above to continue receiving medical benefits. The customer has 30 days to complete the REDE. If the medical REDE is not received within 20 days, a reminder notice Form 643RNW is mailed. Form 643RNW instructs the customer to submit the REDE form or use another method to complete the REDE process.

Note: the SNAP and cash REDE is due by the first day of the month in the last month of the certification period.

Step 1- Medical REDE Selection Process

Criteria for Medical Auto-REDE

The medical programs/services described below are potentially eligible (non-excluded) for auto-REDE:

  • All Kids Assist (non-spenddown)
  • All Kids Share
  • All Kids Premium Levels 1 & 2
  • Moms & Babies (non-spenddown)
  • FamilyCare
  • ACA Adult
  • Former Foster Care
  • SSI recipients receiving AABD Medical
  • SSI recipients receiving long term care (LTC)-nursing home, Supportive Living Facility (SLF), Department on Aging (DoA) or shelter care services
  • Disabled Adult Children (DAC), Widow(er) and Section 1619 cases

Exclusions to Medical Auto-REDE

By Program and Service

The following programs and services are excluded from auto-REDE:

  • Cases in medical extension
  • Cases in spenddown status
  • AABD medical (does not receive SSI)
  • Medicare Savings Program (QMB, SLIB, QI-1)
  • Any medical program when the individual is receiving LTC-nursing home, SLF or DoA (and does not receive SSI)
  • Shelter care services (medical and medical spenddown)
  • Health Benefits for Workers with Disabilities (HBWD)
  • Veterans Care
  • Health Benefits for Persons with Breast or Cervical Cancer (BCC)

Special Case Conditions

The following situations in IES disqualify a case from being selected for auto-REDE.

  • Clearance information from Step 2 below that conflicts with data on file in IES for the persons in the case;
  • Cases with persons who are counted in a medical EDG in more than one case;
  • Cases containing persons for whom the SSN, U.S. citizenship or immigration are not verified in IES;
  • Persons who are included in the EDG whose identity/relationship/income is unknown in IES including cases still showing the source of the information is from "conversion"; and
  • Cases where benefits issued in the CDB do not match benefits determined in IES for one or more persons.

In IES, the Conversion Summary Information must show there are no unknown relationships, no potential merge cases and no discrepancies in benefit match with SNAP and cash assistance.

Example 1: Mr. Alpha is active on an adult only FamilyCare case and is RPY for his children on a separate All Kids case. Mr. Alpha is not eligible for auto-REDE. 

Example 2: Mr. Bravo is an SSI recipient and active on an AABD case. There are 3 people in the standard.  The CDB does not list any information regarding the other 2 people or their relationship to Mr. Bravo.  He is not eligible for auto-REDE.

Example 3: Ms. Charlie is active on an ACA Adult case (EDG size = 1) and her only income is UIB of $500/month.  However, she is a component household member on a separate SNAP case where she has earned income of $1,400 per month (which exceeds the standard for ACA Adult). She is not eligible for auto-REDE. 

Step 2- Medical REDE Clearances 

Approximately 75 days prior to the REDE due date (after cutoff of the 3rd month prior to certification end date), IES runs certain clearances for all medical cases due for a REDE. The clearance results determine if a non-excluded case qualifies for auto-REDE. For cases that do not qualify for auto-REDE or are excluded from auto-REDE, IES initiates Process B for a manual REDE.

By the 60th day prior to the end of the certification period, IES sends the appropriate REDE forms. The manual REDE due date is the 1st day of the last month in the current certification period.

For medical only cases, the manual medical REDE (form 643M, 643N or 643X) is pre-populated with information found in the clearances. When the medical household also receives SNAP or cash assistance, the medical form 2381B is pre-populated with information found in the clearances and sent with REDE form IL 444-1893.

Note: the clearance data found 75 days prior to the end of the certification period can only be used for medical eligibility and cannot be used to determine eligibility for SNAP or cash.

Example 4: Mr. Delta was approved for medical benefits with a certification period Jan 2016 through Dec 2016.  Clearances are run on 10/18/2016 (about 75 days prior to the end of the cert period 12/31/2016). A REDE notice (Process Form A or B) is mailed by 10/31/2016. The REDE due date is 12/01/2016.

Clearance Results

IES reviews the following sources during the clearance check:

  • The Work Number (TWN) and AWVS for earned income;
  • The IES case record for unearned income.  The IES case record is updated regularly through various interfaces;
  • Secretary of State for residency;
  • The IES case record for other non-financial data.

If the income found electronically for each individual is within the medical income standard, IES will proceed with auto-REDE for the case. For cases not excluded from auto-REDE, IES will compare the IES case information to the clearance results. The table below lists the conditions under which a case will qualify for auto-REDE. Cases that fail this step are routed to the manual REDE process (B).

Income on IES Case Prior to REDE Income from Step 2 Clearances  Qualifies for Auto REDE / Process A
Earned income only or both earned and unearned income TWN or AWVS clearance shows income and all individuals remain eligible for medical benefits (even if children are moved to a higher level such as from Assist to Share) Yes
Earned income No income is returned by TWN or AWVS No
Unearned income only TWN or AWVS clearance shows no income Yes
No income TWN or AWVS clearance shows income and all individuals remain eligible for medical benefits Yes
No income No income is returned by TWN or AWVS No

Electronic Data Not Available

The case cannot be selected for auto-REDE if financial or non-financial data cannot be verified electronically:

  • Households with income that cannot be verified electronically include self employment income, private pensions/retirement benefits, unemployment benefits received from another state and other unearned income; or
  • Persons for whom IL residence cannot be verified electronically during the clearance process.

Auto-REDE (Process A)

IES generates Form 2381A to inform the customer of continued eligibility. On cutoff of the last month of the certification period, IES will automatically run eligibility and certify the medical REDE action.  The automated action is completed in the following circumstances:

  • No change in income and non-financial criteria are met; or
  • Based on income, a child is moved to a different program between All Kids Assist, Share or Premium Levels 1 & 2.

Note: IES will not centrally terminate medical benefits due to income found in the Step 2 clearance process for auto-REDE. When clearances reveal income that exceeds the limit, IES will divert the case to the manual REDE process.

If the customer's circumstances have changed since the auto-REDE process was initiated, they have 30 days to report the change before IES automatically certifies the results described in Form 2381A.  If the client reports a change during the 30 day period, refer to the section on Responding to a Change for an Auto-REDE Case later in this release.

Children in households where income is more than the standard for the program for which they are enrolled but less than the standard for All Kids Premium Level 2 will have their All Kids eligibility changed from one program to another automatically.

Example 5: Ms. Echo, active on an ACA Adult case, receives an auto-REDE notice 2381A. IES checks the clearances from Step 2 and finds the data is consistent with information on file in IES. No changes are required. IES auto-certifies the results on cutoff of the last month in the certification period.

Example 6: Mr. Foxtrot has an All Kids Share case for his son.  He receives the auto-REDE notice 2381A telling him that his son will start receiving All Kids Premium Level 1 effective January. Mr. Foxtrot received an increase in his work hours earlier in the year which was reflected in the amount of income shown on his notice. IES updates the EDG and certifies the results on cutoff of the last month in the certification period.

Example 7: Ms. Golf has an active All Kids Premium Level 2 case for her daughter.  Ms. Golf receives the auto-REDE notice 2381A telling her that her daughter will receive All Kids Premium Level 1 effective January.  Ms. Golf changed jobs and is making less money per month than in her previous job. IES updates the EDG and certifies the results on cutoff of the last month in the certification period.

Manual REDE (Process B)

IES will select all medical cases for Process B if the case:

  • Does not qualify for auto-REDE following the clearance step; or
  • Is excluded from auto-REDE.

The client has 30 days to respond to the medical REDE. When the REDE is received by mail or through ABE, the date the REDE was received is recorded in IES to prevent auto-cancelation of medical or cash assistance. If the client doesn't respond to the medical REDE, IES will auto-cancel for failure to complete the REDE.

If the household receives SNAP, the SNAP will end when the certification date expires unless a SNAP REDE is completed to reset the SNAP benefit certification period for another year. Receipt of the SNAP REDE will not stop IES from ending the SNAP if the REDE hasn't been completed by cutoff.

IES will auto-populate forms for the medical REDE depending on the type of REDE form generated for the medical household.

Households Receiving Medical Only

Form 2381 Time to Renew is sent with the auto-populated medical REDE form 643M, 643N or 643X.  The medical REDE forms are auto-populated with data found in the clearances.

Households Receiving Medical with SNAP and/or Cash

Form 2381B Time to Renew is auto-populated with data found in the clearances and sent with the SNAP, Cash and Medical REDE form 1893.

Step 3- Processing the Medical REDE

Auto-REDE (Process A)

For customers who receive the auto-REDE notice and do not report a change, IES will automatically perform the following action (on cutoff in the last month of the certification period):

  • Run eligibility using information in data collection; and
  • Certify the REDE.
Auto-REDE Results Data Collection Update Step Certification Step Notice Sent
No change in medical eligibility IES automatically runs eligibility using information from Step 2 clearances and existing data in IES IES certifies results & REDE date is set for a new certification period Form 2381A sent 60 days prior to the end of the certification period.  No additional notice is sent.
Change in medical program required IES automatically runs eligibility using information from Step 2 clearances and existing data in IES. New EDGs are formed; individuals may be moved into different medical EDGs IES certifies results & REDE date is set for a new certification period Form 2381A sent 60 days prior to the end of the certification period indicating the change.  No additional notice is sent.
Change reported by customer Worker updates data collection with new case information; new EDGs may be formed Worker certifies results & REDE date is set for a new certification period Form 360C sent when worker certifies the change in IES.
Customer receives SNAP or cash assistance Worker interviews customer, reviews verification provided for SNAP or cash assistance and updates data collection so that income is the same for all programs Worker certifies results & REDE date is set for a new certification period Form 360C sent when worker certifies the change in IES.

Responding to a Change for an Auto-REDE Case

If a customer reports a change or disagrees with the information listed on Form 2381A (auto-REDE), do not require the customer to complete a redetermination form.The worker updates data collection/case change with the new information. IES will generate the form Verification Checklist (VCL) if verification is required.

When the verification is received, go to data collection/case change, update the case. Certify the result in IES. If the updated information results in ineligibility for medical benefits, IES will generate a 360C to notify the individual of the change.

Example 8: Ms. Hotel receives FamilyCare for herself and All Kids Assist for her daughter.  Ms. Hotel receives an auto-REDE notice 2381A informing her that her family is eligible to continue receiving FamilyCare and All Kids Assist.  Ms. Hotel reports that she is now married and pregnant. She requests medical coverage for her spouse who has no income of his own.  Generate a Form 243A-C Request for Medical Benefits for an Additional Household Member from Correspondence/Manual forms.  Update Ms. Hotel's status to show she is pregnant in IES by going to data collection/case change.  Certify the result. When Form 243A-C is returned, update IES, run eligibility and certify the result.

Example 9:  Mr. India, active on an ACA Adult case, receives an auto-REDE notice 2381A informing him that he is eligible to continue receiving ACA Adult.  He reports a new address in Manage My Case through ABE. Review the IES task.  The new address is in Illinois, and no other changes are reported.  Go to data collection/case change to update the address and certify the result. The case remains on track for an auto-REDE.

Example 10: Ms. Juliet, an SSI recipient and active on an AABD case, receives an auto-REDE notice 2381A informing her that she is eligible to continue receiving AABD.  Ms. Juliet contacts the FCRC directly and reports that she moved out of state.  Go to data collection/case change in IES: update the address, run eligibility and certify the results.  IES sends a form 360C Notice of Decision informing her that she is ineligible due to not being an Illinois resident. 

Manual REDE (Process B)

Upon receipt of the completed manual REDE, update data collection, run eligibility and certify the result in IES to process the REDE. Continued eligibility or changes in eligibility are per eligibility rules in IES.

Workers must update IES and certify manual REDE cases by cutoff.

Medical Household Receives SNAP and/or Cash Assistance

Households receiving SNAP and/or TANF or AABD cash assistance must complete the manual REDE process described in PM 19-02-01, PM 19-02-03 or PM 19-07-00. Households receiving TANF or AABD cash assistance must complete a face to face interview and Form 1893 SNAP and/or Cash Redetermination. Households receiving SNAP must complete a face to face or phone interview and Form 1893 SNAP and/or Cash Redetermination.

Verified Income is Different for SNAP and/or Cash than for Medical

If AWVS is the source of electronic earnings verification used for the auto-REDE for the medical case, additional verification will be required for SNAP and cash. AWVS is not considered acceptable proof of earnings for SNAP or cash.

When a customer receives the auto-REDE notice for medical, if the electronic source of earnings is AWVS, it may not be used for a SNAP or cash budget.  IES will not permit certification of the medical EDG if income is different between the two programs. When the income is verified for SNAP, take the case out of auto-REDE mode by going into data collection/change, update the income and certify the change. If the customer fails to cooperate with the SNAP REDE by the due date, the SNAP benefits end.  No further update is needed for medical.

A child is not guaranteed continuous eligibility coverage in the medical program indicated on the auto-REDE notice if income verified for SNAP or cash REDE is at a level that changes the child's eligibility. Income verified for medical, cash and SNAP must be consistent in IES to certify eligibility. 

Example 11:  Mr. Kilo receives FamilyCare for himself, his wife, All Kids Assist for his daughter and SNAP benefits.  Mr. Kilo receives an auto-REDE notice for medical telling him that FamilyCare and All Kids Assist will continue.  Mr. Kilo completes the SNAP REDE interview and provides check stubs from his employment.  The check stubs show income that is higher than the limit for FamilyCare and All Kids Assist.  His daughter is now eligible for All Kids Share. Update the income for medical and SNAP and certify the results.  The daughter is not entitled to continuous eligibility under All Kids Assist because additional verification of income became available in the course of reviewing SNAP eligibility.

Example 12: Ms. Lima receives ACA Adult and SNAP for herself. Ms. Lima receives an auto-REDE notice telling her that she is eligible for ACA Adult and that she must complete a REDE for SNAP.  IES verified her income for the auto-REDE using AWVS.  Following the SNAP interview, Ms. Lima does not respond to the VCL to provide proof of her earnings for SNAP.  The SNAP REDE is denied.  No further action is required for ACA Adult because no additional income verification was received. IES will certify the medical REDE at cutoff.

Example 13:  Mr. Mike receives SNAP for his family and All Kids Assist for his son.  Mr. Mike receives an auto-REDE notice telling him that his son remains eligible for All Kids Assist.  IES verified his earnings of $3,000 per quarter using AWVS.  Following the SNAP interview, Mr. Mike provides his check stubs showing $995 after income averaging for the last 30 days. Even though Mr. Mike's son continues to be All Kids Assist eligible with this verified income, update IES to show the amount verified for SNAP. The worker must certify the result for SNAP and medical.

Alignment of Certification Periods by REDE Scenario

IES aligns the certification periods of SNAP, cash and medical when benefits are added to a case.

  • When cash assistance is added to a case with an ongoing medical Eligibility Determination Group (EDG), a new medical certification period will be aligned with the cash certification period.
  • When SNAP assistance is added to a case with an ongoing medical EDG, a new medical certification period will be aligned with the SNAP certification period.
  • When SNAP assistance is added to a case with an ongoing cash EDG, the SNAP certification period will be aligned with the existing cash certification period.
  • When Medicare Savings Program (MSP: QMB, SLIB, QI-1) is added to a case with an ongoing medical EDG, the MSP certification period will be aligned with the existing medical certification period.
  • If a child or adult added for medical benefits to a medical EDG, IES will align the added individuals' certification period with the certification period of the existing medical EDG.
  • If a SNAP REDE is performed prior to the medical REDE due date, the SNAP REDE is used as an ex-parte review for medical. The certification dates for SNAP and medical will be aligned if the individual is eligible for continued medical benefits. If the individual is not eligible, medical benefits will end except for children and pregnant women who will continue to be eligible until the end of their certification periods.

The following table lists the REDE forms that will be generated based on the type of case due for a REDE.  The REDE forms are highly dynamic and designed to display only relevant questions based on MAGI or non-MAGI budgeting methodologies, long term care and SNAP and cash assistance.

Certification Periods by REDE Scenario Medical REDE Process Cash/SNAP REDE Process REDE Forms REDE Action Taken*
Medical only Process A - Auto REDE --- 2381A Medical Benefits Redetermination Notice IES mass change certifies the REDE on cutoff.
Medical only Process B -  Manual REDE ---

2381 Medical Benefits:Time to Renew; and

643 (M, N or X) Medical Benefits Renewal Form

Worker reviews medical REDE, updates IES and certifies case.
Medical due before SNAP Process A -  Auto REDE Manual SNAP REDE

2381A; and

1893 SNAP Redetermination Form

IES mass change certifies the medical REDE on cutoff.

Worker updates IES and certifies the case for SNAP.

Medical due before SNAP Process B - Manual REDE Manual SNAP REDE

2381B Medical Benefits: Time to Renew; and

1893 SNAP Redetermination and Medical Renewal Form

Worker reviews medical and SNAP REDE, updates IES and certifies case.
SNAP due before Medical --- Manual SNAP REDE 1893 Worker reviews SNAP REDE, updates IES and certifies case.
Medical and Cash certification periods aligned (no SNAP) Process A - Auto REDE Manual Cash REDE

2381A; and

1893

Worker reviews Cash REDE, updates IES and certifies the result.  If information reported for cash is different than information for medical, update medical information in IES and certify the result.
Medical and Cash certification periods aligned (no SNAP) Process B - Manual REDE Manual Cash REDE

2381B; and

1893

Worker reviews Medical and Cash REDE, updates IES and certifies the result. 
Medical, Cash and SNAP certification periods aligned Process A - Auto REDE Manual Cash and SNAP REDE

2381A; and

1893

Worker reviews Cash and SNAP REDE, updates IES and certifies the result.  If information reported for cash or SNAP is different than information for medical, update medical information in IES and certify the result.
Medical, Cash and SNAP certification periods aligned Process B - Manual REDE Manual Cash and SNAP REDE

2381B; and

1893

Worker reviews Medical, Cash and SNAP REDE, updates IES and certifies the result. 
SNAP only --- Manual SNAP REDE 1893 Worker reviews SNAP REDE, updates IES and certifies the result. 

*When the household receives cash or SNAP with medical benefits, the income information must be consistent or IES will not certify the results.  When income discovered in the clearance process for the medical auto-REDE is below the program standard, the worker updates the income in IES with income amounts verified for the cash or SNAP REDE.  Certify the result.

Information regarding certification periods at REDE in IES is addressed in a release that will be posted soon.

Reasonable Compatibility

Reasonable compatibility for medical income verification is added to the manual.  This release clarifies how to apply this policy.

Reasonable compatibility is the standard for determining if electronic verification of income is acceptable for medical cases.  When reported income is less than the standard and the income verification obtained electronically is more than the income standard, apply the reasonable compatibility standard to determine if additional verification or information is needed.  Note: when the source of electronic verification is The Work Number (TWN), do not perform a reasonable compatibility calculation. TWN is a current source for income verification.

Consider income to be reasonably compatible when the Federal Poverty Level (FPL) of the income reported on the application is within 5% of the income the caseworker obtains from a source other than the applicant. 

Perform a reasonable compatibility calculation when an income tax return is used as proof of income.

If the reported income is greater than the income standard for the individual's household size, the individual is not eligible due to excess income.

Reported Income Income Obtained from Other Sources Reasonable Compatibility of Reported Income to Verified Income Worker Action
Below the Standard Below the standard Not needed Use the reported income. No further proof is needed.
Below the Standard Above the standard Reasonably compatible (within 5%) Use the reported income. No further proof is needed.
Below the Standard Above the standard Not reasonably compatible (greater than 5%) Contact the customer for an explanation and additional verification if appropriate.
Above the Standard Below or above the standard Not needed Use the reported income.  No further proof is needed.

IES determines reasonable compatibility of reported income at application and for a manual REDE when electronic sources of income are available through clearances. To view the reasonable compatibility calculation in IES, run eligibility then click on the reasonable compatibility tab in the EDG summary. In situations where clearance data is not available, reasonable compatibility can be calculated manually comparing reported income and the hard copy proof of income. A reasonable compatibility calculator (pdf) is also available.

To determine if the difference between the reported income and the income from another source is within 5%, follow the steps below. For the income reported on the application, use the income averaged amount (PM 15-04-02). Use common rounding to determine each percentage amount.

  1. Determine the percentage of the FPL of the reported income.
  2. Determine the percentage of the FPL of the income from another source.
  3. Subtract the lower result from the higher result from steps 1 & 2 to determine if they are within 5% of each other. 

The FPL is the same as the income standard for AABD (100% of the FPL).  To determine the percentage of FPL of the reported income or the income from another source, divide the income by 100% of the FPL for the household size.

Example 14: Mr. November lives by himself and requests ACA Adult coverage. He reports his monthly earned income is $315 per week.  The income averaged amount is $1,354.  An electronic data match shows his income is $1,375 per month.  The income standard is $1,366.  100% of the FPL for a household size of 1 is $990 (hint- use the AABD income standard to determine the monthly amount for 100% of the FPL).

$1,354 divided by $990= 1.367 or 137%

$1,375 divided by $990= 1.388 or 139% 

139% minus 137%= 2% 

Since the difference between the reported income and income verified from another source is 5% or less, the amount reported is reasonably compatible and no further verification is needed.

Example 15: Ms. Oscar and her husband applied for ACA Adult coverage. She reports her monthly earned income is $315 per week and her husband's earned income is $75 per week.  The total income averaged amount is $1,676.  Electronic sources show the combined income is $1,870. The income standard is $1,842.  100% of the FPL for a household size of 2 is $1,335 (hint- use the AABD income standard to determine the monthly amount for 100% of the FPL).

$1,676 divided by $1,335= 1.255 or 126%

$1,870 divided by $1,335= 1.400 or 140% 

140% minus 126%= 14% 

The reported income is not reasonably compatible with the electronic income because the difference between the two is more than 5%.  Contact Ms. Oscar to get an explanation of the discrepancy and verification of her and her husband's income.

MANUAL REVISIONS

[signed copy on file]

James T. Dimas

Secretary, Illinois Department of Human Services

Felicia F. Norwood

Director, Illinois Department of HealthCare and Family Services

Forms referenced:

243A-C

643M

643N

643X

1893

2381

2381A

2381B

VCL (267)