GIS 12 MA/015: Income Attestation at Renewal

The purpose of this General Information System (GIS) message is to inform local departments of social services of a change to one of the income attestation rules used at renewal. This change is effective for redeterminations of eligibility made on or after June 1, 2012.

In accordance with 08 OHIP/ADM-4, "Renewal Simplification for Medicaid and Family Health Plus Recipients," when an individual is enrolled in Family Health Plus (FHPlus) and reports income under the Medicaid level, if there is no "hit" on the Resource File Integration (RFI) sub-system, the rule requires the worker to request income documentation from the recipient. Effective June 1, 2012, documentation will not be required in this situation. Instead, the worker is instructed to budget the attested income and change the coverage to Medicaid coverage.

The attached "Income Attestation at Renewal" desk aid, Attachment I of 08 OHIP/ADM-4, has been revised to reflect this change.

Please direct any questions to your local district liaison.

Income Attestation at Renewal: If Currently Enrolled in Medicaid

Amount reported on Renewal	RFI	Required Action
MA eligible	Under MA Child(ren) over expanded level Under FHP Over FHP	Budget amount reported & keep in MA Send doc. checklist and pend/defer* Budget RFI, move to FHP/send notice* Send doc. checklist and pend/defer
FHP eligible	Under MA Under FHP Over FHP	Budget amount reported & move to FHP Budget amount reported & move to FHP Send doc. checklist and pend/defer
Ineligible for MA and FHP	Under MA Under FHP Over FHP	Budget amount reported rather than RFI; close or FPBP Budget amount reported rather than RFI; close or FPBP Budget amount reported rather than RFI; close or FPBP
No Hit on RFI (in calendar quarter immediately preceding current quarter)	Amt. reported under MA level Amt. reported under FHP level Self-employed, only if downgrade Amt. reported over FHP level	Budget amt. reported, keep in MA Budget amt. reported, move to FHP Request documentation Close case (or move to FPBP)

*Because FHP level for parents exceeds the FPL for children over age one, always pend/defer entire case and request documentation before discontinuing a child when RFI amount exceeds reported income and results in the child's ineligibility.

Note: For excess income cases, if a discrepancy exists, always request documentation unless the entire household income can be verified via Bendex.

Income Attestation at Renewal: If Currently Enrolled in FHPlus

Amount reported on Renewal	RFI	Required Action
MA eligible	Under MA Under FHP Over FHP	Budget amt. reported and move to MA Budget RFI, keep in FHP* Send doc. checklist and pend/defer
FHP eligible	Under MA Under FHP Over FHP	Budget amount reported, keep in FHP Budget amount reported, keep in FHP* Send doc. checklist and pend/defer
Ineligible for MA and FHP	Under MA Under FHP Over FHP	Budget amount reported rather than RFI; close or FPBP Budget amount reported rather than RFI; close or FPBP Budget amount reported rather than RFI; close or FPBP
No Hit on RFI (in calendar quarter immediately preceding current quarter)	Amt. reported under MA level Amt. reported under FHP level Self-employed, only if upgrade or downgrade Amt. reported over FHP level	Budget amt. reported, and move to MA Budget amt. reported, keep in FHP Request documentation Close case (or move to FPBP)

*Because FHP level for parents exceeds the FPL for children over age one, always pend/defer entire case and request documentation before discontinuing a child when RFI amount exceeds reported income and results in the child's ineligibility.

Note: For excess income cases, if a discrepancy exists, always request documentation unless the entire household income can be verified via Bendex.