# WAG 15-05-02: Family Health Plans (Except Family Assist), ACA Adults and Family Planning

PM 15-05-02

See Policy Memo: Verifications for Medical Programs.

Use the person's income from the last 30 days to project ongoing income unless a change in income is expected.

## Use 'Best Estimate' When a Change in Income is Expected

If the person says the amount is expected to change or they have not received any wages yet, figure the amount of wages expected to be received by using best estimate. Best estimate is based on the person's statement of what the income will be. For earned income, figure the amount of wages expected to be received based on:

• the rate of pay or hourly wage,
• the number of hours expected to work, and
• the number of pays expected.

Document the method used to project the future income.

## Reasonably Predictable Decrease in Income

When a reasonably predictable decrease in income is verified, determine the current monthly income by projecting the annual income and dividing the amount by 12. Take into account a reasonably predictable decrease in income when:

1. a person's income changes from month to month,
2. the person's income can be predicted for the next 12 months, and
3. verification of the predicted income is provided.

Example: Tim works as a lifeguard during the spring and summer. He earns \$1,500/month for six months of the year, but does not earn a paycheck between October and March. Tim applies for medical benefits on June 1st. He provides paystubs for the last 30 days and a copy of his employment contract.

1 2 Does Tim's monthly income vary? Yes, he earns income for only six months in the year. Can Tim's income be predicted for the next 12 months? Yes, his anticipated income for the 12 month certification period is expected to be \$9,000 (\$1,500 x 6 months). Is the reported predicted income verified? Yes, Tim provided paystubs and a copy of his 6 month employment contract.

Result: Using reasonably predictable income, Tim's countable monthly income is \$750 (\$9,000/12).

## Reasonably Predictable Decrease in EDG Size

Example 1: Gavin, age 21, moved out of his parent's house in August. He earns \$950 per month while he attends classes part-time. Gavin's parents together earn \$2,950 per month. Because Gavin's parents provided more than half of his financial support for 7-months of the year, they will claim his as a tax dependent for the current year. However, Gavin's parents no longer provide support, and will not claim him as a tax dependent next year. Gavin applies for medical benefits on September 1st.

Result: Since Gavin no longer lives with his parents and reports that they will not claim him as a tax dependent next year, use relationship rules to determine his eligibility for the 12 month certification period beginning September. His countable monthly income is \$950, and his EDG size is one.

Example 2: Ana, age 22, lives with her father and younger sister. Her father will claim both daughters as tax dependents for the current tax year. Ana earns \$800 per month, her father earns \$4,000 per month and her sister has no income. She applies for medical benefits on September 1st and reports that she plans to move out of her father's home in December when she receives more work hours and a raise.

Result: Since Ana's income and household situation have not yet changed, do not take them into account. Her countable income is \$4,800 (\$4,000 + \$800), and her EDG size is 3.