Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 4/2/2025
6121
6122 Reasonable Compatibility - This budgeting method is used as verification of earnings and the lack of earnings. It is used to determine if wages reported by the consumer are generally consistent with information received through a recognized data exchange or other source. If information from the source is reasonably compatible with the customer’s statement, additional information cannot be requested. Income amounts from both the customer and the source are converted to a monthly amount for the reasonable compatibility test; and the amounts are compared.
The reasonable compatibility test only applies to Tier 2 verification and is used for earnings and when no earned income has been reported. When verifying earnings, the applicant must have provided enough information to determine the reported monthly income in order to do the reasonable compatibility test. In situations where the consumer has reported an hourly wage but failed to report the number of hours worked per week, the self-attestation can be determined using an assumed 40 hours per week. When an hourly wage is provided along with a range of hours, the average of the range of hours is used.
Applicable data sources are The Work Number and the wage records on KDOL (BASI). The reasonable compatibility test is performed in KEES. When the Work Number (TALX) is used, the income from the most recent 30 days will be compared to the reported income.
Note: In most cases the income will be calculated prospectively as an average; however, in instances where the employer does not provide a complete income record – specifically, the employer indicates the frequency as ‘hourly’ – actual income received during the 30-day period starting with the anchor date will be used. In most cases, this should be similar to the average income; however, in some cases this may result in inflated income in situations when a consumer is paid weekly or biweekly and receives an extra paycheck within the 30 day period. When this occurs and results in either a denial or incorrect coverage, staff are to research TALX manually and a new prospective amount using the adjusted TALX income must be determined for accurate processing.
When KDOL (BASI) is used, the income from the most recent quarter of the two prior quarters is used to determine an average monthly amount and then compared to the reported income to determine if it can be accepted as verification.
There are two reasonable compatibility tests that are conducted; an individual test and a household-level test. Initially each individual has their income tested to determine if their income is reasonably compatible.
6122.01 Individual Reasonable Compatibility Test - KEES evaluates reasonable compatibility in the order specified below. Reported information is considered reasonably compatible when one of the following is applicable:
a) No earnings were reported and both data sources do not return any earned income, or
b) The amount of earnings reported by the consumer is greater than the amount received from at least one data source for the applicable time frame, or
c) The difference between the self-attested amount and one data source is no greater than 20% of the self-attested amount.
6122.02 Household Reasonable Compatibility Test – Both Below - After the completion of the individual test, each individual will have a reasonable compatibility test conducted against their entire IBU.
The Household RC Test determines if both the amount reported by the consumer and the amount received from one data source are below Medicaid income limits for the applicant. This is known as ‘Both Below’; BOTH self-attestation and income from the data source are BELOW Medicaid. For this RC test, all income in an individual’s IBU is used to determine if it is below the applicable income limit for that person. When the applicant is determined to be Reasonably Compatibility due to Both Below – no income verification is required to complete their determination. They are eligible to receive Medicaid without asking the consumer to provide additional verification of income.
6122.03 Reasonable Compatibility at Review - As part of the review process, KEES will run a Reasonable Compatibility (RC) Batch which will be used to determine the medical review type for all individual recipients due for review.
Due to this, when a pre-populated review is being processed, an RC test might not be required. If the consumer has not reported any changes in income, and the income passed the Reasonable Compatibility Test that was executed by the Batch, it is not necessary to re-run the RC Test. The passing RC test executed by batch is used for the determination. If the RC test executed by batch did not pass, it should still be re-run by the worker at the time of processing, even if no income change has been reported as there may be new data present in KDOL or TALX for the comparison.
The RC test completed as part of the review is valid until the end of the third month following the month the test was executed. A new RC test is required for any review with an older RC test.