WAG 15-04-02: Income (FHP and ACA Adults)

PM 15-04-02

deleted text

Information in revised textWAG 08-03-00 applies to Family Health Plans and ACA Adults.

Verify income at application, reapplication, and whenever information indicates income has changed.

new textUntil IES Phase 2 is implemented: When you find out that an adult or a child age 16 or older has lost employment, enter code 651 EE in Item 80 of Form 552. This includes a person included as a SNAP component member. Enter in the PERSONS column the 4-digit date that represents the calendar month in which the client will receive their last paycheck. Enter the code even if the person is still employed at another job or another person in the case is still employed. Update the code when appropriate.

Example: A client calls on 07/28/15 and reports that she is no longer employed. The client will receive her last paycheck on 08/01/15. Enter code 651 EE in Item 80 with the 4-digit date of 08/15 under the PERSONS column.

Do not verify income at each REDE if proof is already in the case record and the income does not change from month to month. Verify income which changes from month to month (e.g., earned income).

When figuring the amount of income, drop "cents" from each amount to figure the total amount.

Example 1: Ms. B works and is paid weekly. She provides the following pay stubs:

Date Received Gross Amount
04/03 $100.56
04/10 136.74
04/17 159.29
04/24 167.35

To determine Ms. B's gross income, add $100, $136, $159, and $167; for a total of $562.

If Ms. B provides verification that she pays revised textstudent loan interest of $10.50 per week, use $10 per week in determining the income disregard.

Example 2: Ms. D provides the following pay stubs for February (cents have been dropped)

Date Received Gross Amount
02/01 $135
02/08 155
02/15 85
02/22 175
TOTAL $550

 To determine Ms. D's average weekly income, take her total gross income of $550 (dropping cents) and divide by the number of pays in the month (4). The result is her average weekly income of $137 ($550 ÷ 4 = 137.50. The cents have been dropped).

To determine her gross countable income for February, take her average weekly income ($137) and multiply by 4.3. The result is her gross countable income for February of $589 (cents are dropped).

Example 3: Mr. E provides the following pay stubs for March:

Date Received Gross Amount
03/01 $124
03/08 165
03/15 115
03/22 175
03/29 135
TOTAL $714

Mr. E's average weekly income is $142 ($714 ÷ 5 = 142.80. Drop the 80¢). His countable gross income is $610 ($142 X 4.3 = $610.60. Drop the 60¢).

Example 4: Ms. F receives revised textunemployment insurance of $237.50 every 2 weeks.

Her average bi-weekly income is $237 (drop the 50¢). Her countable gross income per month is $509 ($237 X 2.15 = $509.55. Drop the 55¢).

new textExample 5 (Marketplace Income Projection Difference): Tom, a seasonal worker, applies in June and is determined ineligible for the ACA Adult group because his current monthly income is over 138% of the FPL. His application is forwarded to the Marketplace. Tom expects to work only from June through September. The Marketplace determines that Tom's projected annual income will be less than 100% of the FPL. His application is returned for another Medicaid determination. The worker uses Tom's projected annual income, divided by 12, to determine his countable monthly income. The worker completes case notes in IES to record the reason projected annual income is used.

Note: In the above example the application was initially denied and forwarded to the Marketplace. However, if you have documentation that the applicant's anticipated annual income is expected to be under 100% FPL, you may use projected annual income divided by 12 to determine eligibility without denying the application first.