Reasonable Compatibility

Tools

Appendix A, MAGI Income with 5% of FPL included and CHIP premium amounts
Appendix B, Reasonable Compatibility Calculator
Using the Reasonable Compatibility Calculator Overview and Instructions

Guidance

Reasonable Compatibility is policy used to determine if the participant must provide information/clarification for income. Reasonable Compatibility is not used to make an eligibility determination. If the household/participant’s statement of income (self-attestation) is below the eligibility threshold for his/her household and the Electronically Obtained Information (EOI) is above, the 10% Reasonable Compatibility test must be completed.

TO APPLY REASONABLE COMPATIBILITY

If completing this task as part of a returned IM-1U, or if the case is Under Renewal, you must first follow steps to Begin Manual Renewal.

1. Locate *Household (HH) size on the FPL Chart
2. Determine the FPL for the program being explored for eligibility based on the HH’s combined self-attested income

NOTE: For MPW applications, always use 196% of the Federal Poverty Level when comparing self-attested income and EOI

1. Compare the EOI to the HH’s combined self-attested income
2. If the HH’s combined self-attested income and EOI are on opposite sides of the MAGI eligibility threshold (income maximum), run the Reasonable Compatibility calculator to determine Reasonable Compatibility
  1. 1. NOTE: If self-attested income is Zero, do not run the Reasonable Compatibility calculator, see Zero Income Not RC section at the bottom of this page
    2. If YES, proceed with the eligibility determination
    3. If NO, explore each individual HH participant’s self-attested income using the Reasonable Compatibility calculator without considering any FPL amount.
      1. Request verification ONLY for any HH participant’s income that does not meet the reasonable compatibility standards.
        
        Utilize First Contact Resolution prior to Generating an IM-31A Request for Additional Information.
        
        Make a comment on the Income Evidence explaining if calculator was used and date.
3. Make a comment on the HoH Person Page to include:
  1. 1. Why the Reasonable Compatibility calculator was used and the percentage difference in the participant’s self-attested income and the EOI.

NOTE: Place a copy of the RC Calculator in the VFR.

NOTE: Paystubs are considered the participant’s self-attestation and hard copy verification of the income. Paystubs trump the information returned by an EOI when there are discrepancies. Use the paystubs as verified income evidence. When paystubs are provided, RC does NOT need to be completed.

*Based on Household Composition rules

Zero Income Not Reasonably Compatible

When a participant’s statement of zero income and available EOI result in eligibility in different program thresholds, obtain clarification. The Reasonable Compatibility calculator is not needed. Attempt to contact the participant by phone to see if the discrepancy can be resolved.

If unable to reach the participant:

1. Create a piece of income evidence reflecting the EOI in question.
  1. 1. Use the name of the business reflected on EOI.
    2. Enter $0 for the income amount.
    3. Add a comment on the income evidence explaining the participant claimed zero income on their application but EOI reflects eligibility in a different program threshold.
2. Generate a 31A specifically asking for clarification of the income discrepancy and verification of income received during the application timeframe.
3. Make a comment on the HoH Person Page.