Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth Eligibility Operations Memo 07-04 February 15, 2007 TO: MassHealth Eligibility Operations Staff FROM: Russ Kulp, Director, MassHealth Operations RE: Automated Match between MA21 and the Department of Revenue (DOR) Introduction Effective February 20, 2007, MA21 will allow workers who are authorized users of Department of Revenue (DOR) information to verify earned income when they are processing reviews for MassHealth, Commonwealth Care, and Uncompensated Care Pool (UCP) benefits selected as part of the Eligibility Review (ERV) Annual Profile process. This function will be available only when processing reviews, and is not intended for maintenance activities. The match process does not come into use if the member submits valid wage stubs and the member’s income is verified using these wage stubs. This memo describes the rules for this new function in MA21. Process for Authorized Users When a case is selected for review, MA21 will request from DOR the member’s most recent quarterly wages. If the most recent quarterly wages information is incomplete, MA21 will request the next most recent quarterly wages. When the review form is returned to the worker and is entered into the system, MA21 will store the DOR wage information for each household member. When a MEC worker who is an authorized DOR user enters the member’s reported unverified income into the earned income (EIN) screen, MA21 will calculate an average monthly income using the most recent quarterly wage information from DOR. MA21 will then compare the calculated average with the unverified reported income. If the member’s reported wages are within five percent (either higher or lower) of the DOR wages, a pop-up window will display the DOR wages and ask the worker if he or she would like to use the DOR validation to verify the member-declared earned income. At this time, the worker will need to verify that the DOR wages are from the same employer as the wages reported on the review form. If they are from different employers, the worker enters an N(o). If they are from the same employer and the worker enters a Y(es), MA21 will automatically verify the member’s reported earned income, which is within five percent of the DOR quarterly income. The member’s reported income will be verified and the verification indicator will be populated with a D (DOR verification). If the worker enters an N(o), MA21 will follow its usual procedure and issue a VC1 requesting verification of the unverified income. Attachment Attached to this memo are the instructions and MA21 screens for this process. Questions If you have any questions about this memo please have your MEC designee contact the Policy Hotline. EOM 07-04 February 15, 2007 Attachment Processing Reviews with Department of Revenue (DOR) Earned Income Information Entering earned income for a member who has a DOR review Use the EIN event to select the appropriate member. When the Earned Income window is displayed, enter the income information as usual. In the following example, Larry Smythe works at the LV Collision company. He has self-declared (not verified) gross monthly income of $980. If all of the following conditions exist: * the income is not verified; * the user has secure access to the DOR information that resides on MA21; * the most current quarter DOR is available; * the DOR information states the member’s income within 5% (plus or minus) of the member’s self-declared income amount; and * the same number of employers exist on MA21 as are reported by DOR then the Verify Person/Member Earned Income pop-up screen will be displayed. Notice the upper right section of the Verify Person/Member Earned Income screen. The DOR reporting quarter and year used for the income comparison are displayed. In this example the comparison is based on DOR income information for the 3rd quarter of 2006. This is the most current information at this time. Note: If there is more than one DOR-reported income for this member, the employer(s) for the additional reported income will also be listed. In this example, the member has one income source reported by DOR. If there is more than one employer, and only one income is verified, the pop-up screen will not be displayed. A VC1 will be issued for the unverified income. The left side of the Verify Person/Member Earned Income screen shows the MA21 current earned wages as entered on the EIN screen, along with the name of the member’s employer. The right section shows the current average monthly wages as reported by DOR, along with the name of the employer associated with this income. Ensure that the same employer is identified by MA21 and DOR. A Yes/No response is required for the, “Do you want to use DOR information to verify all reported income?” question. A Y(es) response allows you to verify the member’s income based on the DOR information. A N(o) response will cause a VC1 to be issued for the unverified income. When necessary, the List DOR option can be used to display the quarterly wages used to determine the DOR monthly average earnings. To display this information, enter Y(es) in the List DOR field. The List Person DOR Quarterly Information screen will be displayed. Enter S(elect) to the left of the most current quarter and press Enter. The DOR Quarterly Information screen, shown below, will appear. The employer information shows the gross wages for the selected quarter. Return to the Verify Person/Member Earned Income screen by pressing PF2 twice. To accept the DOR information as verification of the member’s earned income, enter Y(es) as the response to the “Do you want to use DOR Information to verify all reported income?” question. When the List Earned Income screen is redisplayed, the Verified field will display D(OR). This income was verified based on DOR information. Modifying existing earned income using DOR information In the following example, the member has existing verified income on MA21. The income information shown on the DOR review shows the same employer, but the income amount differs from the existing MA21 information. To modify the existing information, enter M(odify) in the action field. The Earned Income screen will be displayed. Type over the (+) in the Gross income field with an X. When the Earned Income window opens, enter the Effective Date, Gross Amount, Number of Hours, and the appropriate verification indicator associated with this income entry. Confirm the modification. If the income is not verified, and it is within the 5% (plus or minus) of the income reported by DOR, the Verify Person/Member Earned Income pop-up screen will be displayed. A Yes/No response is required for the, “Do you want to use DOR information to verify all reported income?” question. A Y(es) response allows you to verify the member’s income based on the DOR information. A N(o) response will cause a VC1 to be issued for the unverified income. Modifying income on MA21 when the employer reported by DOR is not the same employer recorded on MA21 In the following example, the member has verified income reported on MA21. The member’s DOR review form does not include this employer. To view the DOR information for the member, return to the Record Person Events screen and enter DOR as the Event. Press Enter. The List Household DOR Information screen will appear. Notice that Quarterly information is available for this member. To display the Quarterly information, enter QT to the left of the member’s name and press Enter. The List Person DOR Quarterly Information screen will appear. Notice that this member has only one employer reported by DOR. To view detailed information, enter S(elect) to the left of the current quarter used for the DOR review. The DOR Quarterly Information screen will be displayed showing the gross wages used by DOR to determine the member’s gross monthly income. In the following example, the member has gross wages of $3,000, which is expressed as a monthly gross of $1,000. Return to the Record Person Events screen. Enter EIN as the event. When the List Earned Income screen is displayed, use the Modify selection and END the income for the income source that is not reported by the member or DOR (BDS Company). Add the new income information as reported by the member. If the income is not verified, and within the 5% limit (plus or minus) of the income reported by DOR, the Verify Person/Member Earned Income pop-up screen will be displayed. A Yes/No response is required for the, “Do you want to use DOR information to verify all reported income?” question. A Y(es) response allows you to verify the member’s income based on the DOR information. A N(o) response will cause a VC1 to be issued for the unverified income. If the Y(es) response was selected, the List Earned Income screen will have D(OR) in the Verified field. Removing the DOR verification indicator from previously verified income In the following example, the member’s income was verified using DOR information. The member has reported an additional source of income, which has not been reported on the member’s most current DOR Quarterly report. Enter the new income source on MA21. In this example, the member has reported an unverified income source that is not on the current DOR Quarterly report. When ENTER is pressed to confirm this income, the UnDo Person/Member Earned Income pop-up window appears on the Verify Person/Member Earned Income screen. Any of the following conditions will cause previously verified DOR income to become unverified. * There is not a direct correlation between the number of employers on MA21 and the number of employers reported through DOR. * The reported income is no longer within the 5% limit (plus or minus). * One income source has DOR verification and another is either not verified or has been verified by a worker. The DOR verification indicator D(OR) is changed to N(o). This now unverified income source will be included on the VC1. Press PF2 to return to the List Earned Income screen. When the List Income screen is displayed, the Verification field contains N(o) for both income sources. Remember that when any of the following conditions exist: * the number of earned income entries on MA21 does not match the number of employers reported through DOR (there is not a direct correlation between the income sources on MA21 and those reported by DOR); * DOR was used to verify one income source and the household has another earned income source that has been verified by a worker (not DOR); or * the member’s income is not within the 5% limit (plus or minus) DOR information cannot be used to verify income. Using MA21 Query to identifying DOR verified information Select MA21 Query as the User Menu option. When the MA21 Query screen is displayed, enter EIN as the event. The Earned Income for HH: MEMBER NAME will be displayed. In the following example, the Earned Income for Larry Smythe is displayed. The Verified indicator is D(OR), income has been verified using the DOR information. Notice the List DOR field. To view the DOR employer(s) information used to verify this income, type over the N(o) with a Y(es). When this option is selected, the Verified Earned Income using DOR Information/Browse Employers Used screen appears. This screen is useful when reviewing a case as it displays the DOR monthly wages used to verify the member’s income. In the example below, the member has one employer with reported monthly wages of $926.10. To view the gross monthly wages reported by an employer, position the cursor on the line that displays the desired employer’s name and press Enter. The DOR Quarterly Information screen for the selected employer will be displayed. MA21 automatic removal of DOR verifications When the number of member employers entered on MA21 does not match the number of employers reported by DOR, MA21 will remove any previously entered DOR verifications, and the member will be issued a VC1 for income verification. In the following example, the member has reported income within the 5% limit (plus or minus) and the employer entered on MA21 matches the employer reported by DOR. The worker has decided to use the DOR information to verify this income. When the List Earned income screen is displayed, the verification indicator is D(OR). This member has another source of income. The employer is not included in the DOR quarterly report. Enter the earned income as usual. In this example, the second income is not verified. When PF5 is pressed to confirm the second income source, the UNDO Person/Member Earned Income window is displayed. The window notifies the worker that there is not a correlation between the number of MA21 employers and the employers reported by DOR for the member. When this occurs, MA21 automatically changes any previous DOR verifications to not verified. Press PF2 to return to the List Earned Income screen. Notice the List Earned Income V(erified) field. The verification indicator for both employers is N(o). A VC1 will be issued for income verification.