Eligibility for Family Health Plans, ACA Adults and Family Planning is determined based on countable income for the current processing month.
Countable income is calculated using Modified Adjusted Gross Income (MAGI) budgeting. Policy about countable income and allowable income deductions for FHPs, ACA Adult and the Family Planning programs is in PM 08-03-00. See PM 15-04-02 for policy about income averaging.
Reasonably Predictable Decrease in Income
Consider reasonably predictable decreases in income when projecting expected monthly income for the processing month. Any regular, predictable income fluctuation may be considered, such as a regular summer lifeguard's income or the income of teacher or school bus driver who is paid from September to May. This option could also be applied to a self-employed individual whose income and expenses fluctuate throughout the year.
Take into account a reasonably predictable decrease in income when:
- a person's income changes from month to month,
- the person's income can be predicted for the next 12 months, and
- verification of the predicted income is provided
Acceptable verification of reasonably predictable income changes includes: prior year tax return (if circumstances are the same), a previously verified historical pattern, quarterly wage data, or employment contract or agreement.
Reasonably Predictable Decrease in Eligibility Determination Group (EDG) Size
A change in circumstances that results in different household composition in the current month than the household composition reflected in the tax-filing status for the year may also be taken into account. One example would be a child who is currently claimed as a tax dependent but who has left her home, no longer living with her parents and will not be claimed as a dependent in the future.
A future change, such as marriage planned later in the year or a potential job lead, may not be considered.