Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 00 - Affordable Coverage Groups › Part 5 - Medicaid MAGI Financial Eligibility Determinations and Verification › Section 210-RICR-30-00-5.8 - Medicaid Reasonable Compatibility Standards

Current through June 14, 2024
A.
				  When information obtained through the federal data hub and State data sources
				  is found reasonably compatible with the applicant's attestation, no further
				  verification is required, and the eligibility determination will proceed. The
				  reasonable compatibility standards set forth below by the State are applicable
				  to income verification. The term "data" refers to information obtained through
				  electronic data matches across federal and State sources.
B. Overview of Standards
Medicaid Reasonable Compatibility Standards
								  for Income
Attestation and Data Scenario
Reasonable Compatibility
								  Standard
Attestation and SWICA and UI data are below
								  applicant's Medicaid eligibility levels.
Reasonably Compatible: Person eligible for
								  Medicaid
Attestation and SWICA and UI data are above
								  applicant's Medicaid eligibility levels.
Reasonably Compatible: Person ineligible for
								  Medicaid; eligibility for a qualified health plan (QHP) is determined
The attestation is below the applicant's Medicaid
								  eligibility level and the SWICA and UI data are above the applicant's Medicaid
								  eligibility level, and the difference between the attestation and data is ten
								  percent (10%) or less.
Reasonably Compatible: Person eligible for
								  Medicaid
The attestation is below the applicant's Medicaid
								  eligibility level and the SWICA and UI data are above the applicant's Medicaid
								  eligibility level, and the difference between the attestation and data is
								  greater than ten percent (10%).
Not Reasonably Compatible: pursue discrepancy
								  reconciliation.
Person may provide a reasonable explanation
								  and/or provide the State with documentation of current income.
1. Income
				  attestation and data are both below Medicaid eligibility levels - Attestation
				  and data sources are reasonably compatible if the difference or discrepancy
				  between the two (2) does not affect the eligibility of the applicant. In other
				  words, even if there is a difference between what an applicant says he or she
				  earned and what the data shows was actually earned, the attestation and data
				  are considered reasonably compatible if both are below Medicaid eligibility
				  levels.
2. Attestation and data are
				  both above Medicaid eligibility levels - Attestation and data sources are
				  reasonably compatible if they are both above the Medicaid eligibility levels.
				  Under such a scenario, the person would be found ineligible for Medicaid. For
				  example, this would occur if an applicant attests to income above the
				  eligibility ceiling for the applicable MACC group and electronic data-based
				  verification indicates that the applicant's income is higher than that amount.
				  The applicant is not eligible for Medicaid in either case. Eligibility for
				  affordable care with federal advance premium tax credits and cost-sharing
				  reductions is then reviewed.
3.
				  Income attestation - The difference between the income attestation and the data
				  is less than ten percent (10%) - An income attestation and data from electronic
				  sources are considered reasonably compatible if the difference between the
				  applicant's attestation and the data sources is less than ten percent (10%).
				  The applicant is eligible, provided all other eligibility criteria are
				  met.
4. Income attestation - The
				  difference between the income attestation and data sources is greater than ten
				  percent (10%). An income attestation and data on income sources are considered
				  to be not reasonably compatible if the difference between the applicant's
				  attestation and data sources is greater than ten percent (10%); a reasonable
				  explanation is pursued.