12. How is information on the application verified?

Data matching. When individuals apply online or when agency employees enter the information from a paper or telephone application into the system, the HIX attempts to verify certain key information from federal and state data sources. This information includes, state residence, income, US citizenship or eligible immigration status and certain government-sponsored MEC. In many cases, the system can make a real time determination about the applicant’s eligibility for available programs without requiring any additional proof. 

Paper verification. If information cannot be verified electronically, a notice will go out to the applicant asking for information to be submitted within 90 days. As discussed in the following Q & A, the Health Connector can generally make a temporary eligibility decision based on the self-declared information without having to wait for the paper verification.

Proof of income. The application asks for both current monthly income and expected annual income for each member of the tax household. The information on current monthly income is used to determine eligibility for MassHealth. If an individual is not eligible for MassHealth, expected annual income is used to determine eligibility for advance premium tax credits and ConnectorCare. The system checks federal data sources that include income information from the IRS based on the most recent return filed in the last three years. If the applicant’s selfdeclared annual income is “reasonably compatible” with the data sources it is considered verified. For purposes of ConnectorCare, the attested income is reasonably compatible if it is either higher than the income shown in the data source, or, no more than 10% lower than the income in the data source. 

• Federal law requires a reasonable compatibility threshold of no less than 10% over the attested income amount. The federal Marketplace uses a 25% threshold, but Massachusetts uses the 10% minimum. 

45 CFR 155.315 and 155.320.