MEMORANDUM

DISCUSSION:

This memorandum is to introduce manual updates to the MAGI Prior Quarter policy.

Eligibility determinations should be run separately for each month in the prior quarter, and separately from the application and ongoing months. To be eligible for prior quarter the individual must meet eligibility criteria for each month of the prior quarter period.

When processing applications for the prior quarter months, each month has its own pieces of evidence.

• The individual must meet MAGI eligibility criteria for each month which includes: residency, citizenship/immigration status, income, SSN, tax filing status/relationship, and pregnancy if applicable.
• The individual must attest to having unpaid medical bills in the prior quarter.
• Actual income is used to budget for the prior quarter months.

NOTE: Reasonable Compatibility is not used in the prior quarter months.

• Evidence must be obtained through the electronic data sources or requested from the individual.
• If an individual fails to provide requested evidence, all prior quarter months are rejected for Failure to Cooperate.

NOTE: If the individual later reapplies for prior quarter coverage, only request the unverified evidence.

• Prior quarter coverage can be requested up to one year after the application date.

Reasonable Opportunity does not apply to prior quarter months. If an individual is approved with Reasonable Opportunity for application month and ongoing, reject the prior quarter months.

NOTE: If the individual provides the documentation within the 90 day Reasonable Opportunity time frame, and all evidence has been verified, reopen the prior quarter application and run a determination.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/ks