Reasonable Compatibility Straw Models

Posted September, 18 2012 by arianne

It’s Fall 2013. John Doe discovers he can apply for health insurance through Obamacare’s Health Benefit Exchange in his state. He goes to the website that his employer (who doesn’t offer insurance) told him about and easily fills in the required information, including his income. He enters his annual income as $14,000. The Exchange begs to differ and says, according to its data matching, his income is $17,000. John’s income attestation would make him Medicaid eligible; the income determined from the Exchange’s data matching would make him ineligible for Medicaid.

How should these types of inconsistencies be resolved? What are the “reasonable compatibility” requirements for states? When should documentation be required to resolve inconcistencies? What kind of flexibility do states have to set reasonable compatibility standards?

Deborah Bachrach and Kinda Serafi from Manatt Health Solutions have some answers. In conjunction with Georgetown Center for Children & Families (CCF) and KidsWell, they hosted a webinar on “Reasonable Compatibility: How will States Reconcile Differences in Income between an Individual’s Self-Attestation and Electronic Data Sources?”

The webinar included an overview of reasonable compatibility requirements and how they fit into the new streamlined eligibility framework under the ACA. They reviewed Straw Models for Medicaid, CHIP, and Advanced Premium Tax Credits/Cost Sharing to help identify the most consumer friendly options when a state verifies an individual’s attestation against income data sources. Case examples were used to illustrate how reasonable compatibility standards might work in practice for individuals, like John Doe, at various income levels. Click here to view a recording of the webinar.

Manatt’s Reasonable Compatibility Straw Models can be downloaded from the Robert Wood Johnson Foundation’s State Network website. Be sure to check out the KidsWell and State Network websites. Both have extensive resources on ACA implementation.