MAPS sends the application through verification if:

• •

  the application data indicates less income than the agency income data and,

• •

  the difference in the income amounts result in a change from one subsidy category to another.

EXAMPLE: On October 20, 2023, Alex files for Extra Help with a total countable income (application data) for the applicable period of $15,500 (more than 100% and less than 135% on the 2023 FPL table for a family size of one). The agency data from data matching indicates income of $20,000 (more than 135% and less than 140% on the 2023 FPL table for a family size of one).

MAPS will send the application to verification because:

• •

  the application data falls in the 100% premium full subsidy category and,

• •

  the agency data falls in the 75% premium subsidy category.

IMPORTANT: The Inflation Reduction Act of 2022 (IRA) allows for one Extra Help category. Extra Help eligibility determinations on or after January 1, 2024 indicate the individual is either eligible or ineligible for Extra Help.

MAPS does not send the application to verification if:

• •

  the application data and agency data both indicate income within the same subsidy category, and the system determines full or partial subsidy;

  IMPORTANT: 

  Partial subsidy only applies to applications with effective dates before January 1, 2024.

• •

  the application data and agency data both indicate income above the income limit for Extra Help eligibility (the system automatically issues a pre-decisional notice);

• •

  the application data indicates higher income than the agency data;

• •

  the application data indicates lower unearned income than the agency data, but the applicant answered the question about a recent unearned income decrease affirmatively (Question 10 on the SSA-1020-OCR, Application for Help with Medicare Prescription Drug Costs); or

• •

  the application data indicates lower earned income than the agency data, but the applicant answered the question about a recent earned income decrease affirmatively (Question 14 on the SSA-1020-OCR).

EXAMPLE 1: On July 2, 2023, James files for Extra Help with a total countable income (application data) for the applicable period of $19,800 (more than 135% and less than 140% on the 2023 FPL table for a family size of one). The agency data from data matching indicates income of $20,400 (more than 135% and less than 140% on the 2023 FPL table for a family size of one).

MAPS will not send this application to verification because both the application data and the agency data fall within the 75% premium subsidy category.

EXAMPLE 2: On January 16, 2025, Jacqueline files for Extra Help with a total countable income (application data) for the applicable period of $21,900 (more than 135% and less than 140% on the 2025 FPL table for a family size of one). The agency data from data matching indicates income of $23,000 (more than 140% and less than 150% on the 2025 FPL table for a family size of one).

MAPS will not send this application to verification because both the application data and the agency data fall within the 100% premium full subsidy category.

The Medicare System Query displays data from the Medicare database. The verification screen clearly identifies income from the RRB, VA, and OPM. The verification screen does not show the specific source of the agency data for the income fields “Other Pensions or Annuities” and “Other Unearned Income.” For information on verifying “Other Unearned Income” or “Other Pension or Annuities” income posted on MAPS verification screen (VRAI), see HI 03035.010D in this section and HI 03035.010G in this section.

For instructions on verifying pension and annuity income, see HI 03035.012.

To obtain detailed agency data, access the Detailed Agency Data (DADS) screen by clicking on the “Query” option on the verification screen.

• •

  Review MAPS (application data and images) to identify income exclusions.

• •

  If the applicant incorrectly reported income exclusions, correct the amounts on the income verification screens and document the verification on the MAPS Report of Contact screen (DWRC).

• •

  If unable to identify income exclusions, follow below step 2 and contact the applicant.

To determine whether unspent (retained) income will be a counted resource see, HI 03020.050 Unearned Income Exclusions, HI 03030.001 (What are Resources for Medicare part D?), and HI 03030.020 (Resource Exclusions).

EXAMPLE: On a Medicare Part D Extra Help application, the “other income” field shows the applicant wrote they received three Coronavirus Disease 2019 (COVID-19) pandemic-related Economic Impact Payments (EIPs) payments, ($1,200 in May 2020, $600 in January 2021, and $1,400 in April 2021). The applicant also wrote they saved some of the money they received from the payments. A technician reviews LIS and SSI exclusion policies and determined the dates and payment amounts the applicant wrote are COVID-19 pandemic-related EIPs per SI 00830.622B.

Spent and unspent (retained) EIPs are excluded from resources indefinitely (see SI 01130.623). The technician corrects the income and resource amounts on the verification screens and follows below sections F4 and I instructions in this section (HI 03035.010) and instructions in HI 03035.006 to document the verification determination in MAPS on the DWRC screen.

If you make contact with someone other than the applicant, use caution to avoid improper disclosure. When contacting the applicant:

• •

  Discuss the discrepancy between the application data and the agency data. For instructions on if the applicant dies before we process the Extra Help application, see HI 03010.010E.

• •

  Discuss each type of income with a dollar amount posted in either the “Application” or “Agency” data field of the VRAI.

• •

  Obtain the applicant’s explanation for discrepancies between the income amounts posted in the “Application” and “Agency” data fields.

• •

  Accept the explanation and determine that the application data is the correct amount for the application data income if the applicant provides a reasonable explanation for the application data.

• •

  Inform the applicant that we will use the agency data for the Extra Help determination if the applicant agrees with the agency data.

• •

  Inform the applicant that we will use the agency data for the Extra Help determination unless the individual provides evidence to the contrary if the applicant is not able to provide a reasonable explanation for the discrepancy. To offer assistance for evidence and closeout, see HI 03010.040.

• •

  Assist the applicant in determining the actual amount of the excludable work expenses and input the determined amount if the applicant indicates the actual work expenses are higher than the amount automatically posted by MAPS as impairment-related work expenses (IRWE) or blind work expenses (BWE), see HI 03020.030.

When the CS performs verification for earned income:

• •

  Verify with the applicant that the “Stop Work Date” alleged on the application is correct. If it is not correct, input the correct “Stop Work Date” on the appropriate MAPS screens. Based on the “Stop Work Date” MAPS determines the months for countable earnings. An incorrect date results in incorrectly counting the applicant’s earned income, which can result in an erroneous subsidy determination.

• •

  Input the correct “Stop Work Date” on the MAPS Work Stop Date and Work Expenses for Disability (ATWE) screen for initial applications, or the State Agency Work Sampling (SAWS) screen for redeterminations prior to submitting the case for a Medicare Part D Subsidy Determination. If the applicant has ongoing earned income from the filing date, delete the “Stop Work Date” in MAPS.

• •

  Document the determination to revise or delete the “Stop Work Date” when completing the MAPS Report of Contact (DWRC).

Document the verification determination following procedures in HI 03035.007.

Use the DWRC screen to document:

• •

  verified income amounts;

• •

  types of evidence reviewed;

• •

  FO determination (Resolved or Failure to Cooperate); and

• •

  dates and types of contacts made.

REMINDER: Do not photocopy evidence for the file because you must record all documentation on the verification screens.

Input the verification determination as follows:

a. Select “None,” “Application,” “Agency,” or “New Amount” on the VRAI screen to indicate the correct amount of income for each type of income under consideration.

b. If the applicant reports income not already on the application, input that in the appropriate field.

c. When all income issues are resolved and there are no items marked “Not Verified,” go to the “Issue Resolution” section, select the “Resolved” button, and click on “Submit to Subsidy Determination.”

d. If you made two unsuccessful attempts to contact the applicant by phone and the applicant does not respond to the Evidence Request Notice within the 15-day closeout period, input “failure to cooperate” and click on “submit to subsidy determination.” For additional information on evidence and closeout, see HI 03010.040.

If you select an application for verification that has “Other Unearned Income” reported and the DADS screen has no corresponding detailed agency data, query the MAPS Current Agency Data screen to see if the undocumented unearned income lists as “Unemployment (OCSE).”

If there is a report of “Unemployment (OCSE)” on the MAPS Current Agency Data screen, develop and document the unemployment income following the procedures in HI 03035.010F in this section.

If the applicant’s other unearned income remains unexplained, develop and document the remaining unearned income following the procedures in HI 03035.010F, in this section.

REMINDER: The unexplained “Other Unearned Income” could be the amount of garnished Title II benefits (see HI 03035.010G in this section). For instructions on verifying annuity income, see below section J and HI 03035.012.