MAPS does not send the application to verification if:
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•
the application data and agency data both indicate income within the same subsidy
category, and the system determines full or partial subsidy;
Partial subsidy only applies to applications with effective dates before January 1, 2024.
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•
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);
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•
the application data indicates higher income than the agency data;
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•
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, 2024, Jacqueline files for Extra Help with a total countable income
(application data) for the applicable period of $20,800 (more than 135% and less than
140% on the 2024 FPL table for a family size of one). The agency data from data matching
indicates income of $21,800 (more than 140% and less than 150% on the 2024 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.
IMPORTANT: Effective January 1, 2024, the (IRA) Act of 2022 increased the income limit for full
subsidy from income below 135% of the FPL to income below 150% of the FPL.