Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
6121
6122 Reasonable Compatibility - This budgeting method is used as verification of earnings and the lack of earnings. It is used to determine if wages reported by the consumer are generally consistent with information received through a recognized data exchange or other source. If information from the source is reasonably compatible with the customer’s statement, additional information cannot be requested. Income amounts from both the customer and the source are converted to a monthly amount for the reasonable compatibility test; and the amounts are compared.
The reasonable compatibility test only applies to Tier 2 verification and is used for earnings and when no earned income has been reported. When verifying earnings, the applicant must have provided enough information to determine the reported monthly income in order to do the reasonable compatibility test. In situations where the consumer has reported an hourly wage but failed to report the number of hours worked per week, the self-attestation can be determined using an assumed 40 hours per week. When an hourly wage is provided along with a range of hours, the average of the range of hours is used.
Applicable data sources are The Work Number and the wage records on KDOL (BASI). The reasonable compatibility test is performed in KEES. When the Work Number (TALX) is used, the income from the most recent 30 days will be compared to the reported income.
Note: In most cases the income will be calculated prospectively as an average; however, in instances where the employer does not provide a complete income record – specifically, the employer indicates the frequency as ‘hourly’ – actual income received during the 30-day period starting with the anchor date will be used and should be similar to the average. For a consumer paid bi-weekly who received three paychecks within the 30-day period and is negatively impacted when actual income is used, a new prospective amount must be determined for accurate processing.
When KDOL (BASI) is used, the income from the most recent quarter of the two prior quarters is used to determine an average monthly amount and then compared to the reported income to determine if it can be accepted as verification.
There are two reasonable compatibility tests that are conducted; an individual test and a household-level test. Initially each individual has their income tested to determine if their income is reasonably compatible.
6122.01 Individual Reasonable Compatibility Test - KEES evaluates reasonable compatibility in the order specified below. Reported information is considered reasonably compatible when one of the following is applicable:
a) No earnings were reported and both data sources do not return any earned income, or
b) The amount of earnings reported by the consumer is greater than the amount received from at least one data source for the applicable time frame, or
c) The difference between the self-attested amount and one data source is no greater than 20% of the self-attested amount.
6122.02 Household Reasonable Compatibility Test – Both Below - After the completion of the individual test, each individual will have a reasonable compatibility test conducted against their entire IBU.
The Household RC Test determines if both the amount reported by the consumer and the amount received from one data source are below Medicaid income limits for the applicant. This is known as ‘Both Below’; BOTH self-attestation and income from the data source are BELOW Medicaid. For this RC test, all income in an individual’s IBU is used to determine if it is below the applicable income limit for that person. When the applicant is determined to be Reasonably Compatibility due to Both Below – no income verification is required to complete their determination. They are eligible to receive Medicaid without asking the consumer to provide additional verification of income.