Bounce Back Rule

Babar had no income for the first 6 months of the year and then he gets a job at the Elephant Bar. His CMI determines him as over income for MAGI MC. When he is determined for APTC financial eligibility, his PAI, which includes the 6 months of zero income, is below 100% FPL using the APTC eligibility methodology. Babar is financially eligible for MAGI MC for the entire year until MC RD or Change in Circumstance (CIC), whichever occurs first.

Juliette applies for MC on July 10, 2018. Her application states that she started work at Shake & Speare’s Bookstore on July 1, 2018 and she earns $1,400 monthly. After the EW enters all the appropriate data in CalSAWS, and calls BRE, CalHEERS will grant Juliette MAGI MC appropriately.

Juliette’s monthly income is over 138% FPL; however, her annual income ($1,400 x 6 months = $8,400) is below 100% FPL for her first year of employment based on her employment start date. Therefore, CalHEERS will appropriately grant her MAGI MC instead of APTC/CSR; the Bounce Back Rule applies to her case. If the case is ran any time after January 1, 2019, Juliette will be eligible for APTC/CSR effective the appropriate future month with 10-day NOA.

Note: If Juliette’s income does not change, she will be eligible for APTC/CSR starting January 1st. Her income will be calculated for 12 months ($1,400 x 12 = $16,800) which will be over 138% FPL monthly and over 100% FPL annually.

Aurora applies for MC on July 13, 2018. Her application states that she started work at Beauty’s Mattresses on January 25, 2018 and she earns $1,600 monthly. After the EW completes all other data entries in CalSAWS, as necessary, and calls BRE, CalHEERS will grant Aurora APTC/CSR appropriately.

Aurora’s monthly income is over 138% FPL ($1,600 x 11 months = $17,600) for the entire year. Therefore, CalHEERS will grant her APTC/CSR, not MAGI MC.
Aurora’s income is over the monthly (138%FPL MAGI MC) and annual (100%FPL APTC) income limit, therefore the Bounce Back Rule does not apply to her case.

Mr. Sanders reports a timely CIC on January 28, 2018. He started working at Kentucky Cluckies on January 18, 2018. He earns $347 weekly paid on Fridays. The EW manually converts to monthly income ($347 x 4.33 = $1502.51/ monthly).

After the EW completes all other data entries in CalSAWS, as necessary for CIC, and runs the case to call the BRE, CalHEERS will grant Mr. Sanders APTC/CSR appropriately. Mr. Sanders monthly income is over 138% FPL; ($347/weekly x 4.33 = $1,502.51/monthly), and over 100% for the year ($347/weekly x 4.33 = $1502.51/monthly x 11 months = $16,527.61/annually). Therefore, CalHEERS will grant him APTC/CSR, not MAGI MC.

Mr. Sanders income is over the monthly (138%FPL MAGI MC) and annual (100%FPL APTC) income limit, therefore the Bounce Back Rule does not apply to his case.

Taylor is currently receiving MAGI MC. She submits the June 2019 MC RD on June 14, 2019; however, it is processed July 8, 2019. She started working at Swift’s Karaoke on January 4, 2019. She earns $347 weekly paid on Fridays. The EW manually converts to monthly income ($347 x 4.33 = $1502.51/ monthly).

After the EW completes all other data entries in CalSAWS, as necessary,and calls BRE, CalHEERS will grant Taylor APTC/CSR appropriately (There is no potential eligibility for Non-MAGI MC, therefore she is not entitled to Soft Pause). Taylor’s monthly income is over 138% FPL; ($347/weekly x 4.33 =
$1,502.51/monthly), and over 100% for the year ($347/weekly x 4.33 = $1502.51/monthly x 11 months = $16,527.61/annually). Therefore, CalHEERS will grant her APTC/CSR, not MAGI MC. Losing MAGI MC is considered a life changing event and she is eligible for Special Enrollment. Her APTC Eligibility begins August 2019.

Note: Due to the 10 day timely NOA requirement, EW’s must not re-evaluate the current or any past months in this continuing scenario.

Taylor’s income is over the monthly (138%FPL MAGI MC) and annual (100%FPL APTC) income limit, therefore the Bounce Back Rule does not apply to her case.

Nala reports a Change in Circumstance (CIC) on September 9, 2018. She started working at the Zoo on August 22, 2018. She earns $347 weekly paid on Fridays. The EW manually converts to monthly income ($347 x 4.33 = $1502.51/ monthly).

After the EW completes all other data entries in CalSAWS, as necessary for CIC, and calls BRE, CalHEERS will continue to grant Nala MAGI MC appropriately. Nala’s monthly income is over 138% FPL; ($347/weekly x 4.33 = $1,502.51/monthly), but less than 100% for the year ($347/weekly x 4.33 =
$1502.51/monthly x 4 months = $6,010.04/annually). Therefore, CalHEERS will grant her MAGI MC initially, not APTC/CSR because the Bounce Back Rule applies. If EDBC is run anytime after January 1st 2019, Nala will be eligible for APTC/CSR effective the appropriate future month with 10-day NOA.

Nala’s income will be calculated for 12 months ($1502.51 x 12 = $18,030.12) which will be over 138% FPL monthly and over 100% FPL annually.

Lawrence Hopper reports a CIC on September 9, 2018. He started working as a soccer referee on August 22, 2018. He earns $347 weekly paid on Fridays. The EW manually converts to monthly income ($347 x 4.33 = $1502.51/ monthly). Lawrence also reported that he ended his 2-year job as a piano teacher on July 27, 2018 where he earned $150 weekly .In addition, the EW makes new entries for the new job (soccer referee) information as follows:

After the EW completes all other data entries in CalSAWS, as necessary for CIC, and calls BRE, CalHEERS will continue to grant Lawrence MAGI MC appropriately. Starting in September, Lawrence’s monthly income is over 138% FPL ($347/weekly x 4.33 = $1,502.51/monthly) due to his new job, but less than 100% for the year between both jobs.

• Soccer referee ($347/weekly x 4.33 = $1502.51/monthly x 4 months = $6,010.04/annually)
• Piano teacher ($150/weekly x 4.33 = $649.50/monthly x 8 months = $5196.00/annually).

Since his total annual income is $11,206.04. CalHEERS will grant him MAGI MC initially, not APTC/CSR because the Bounce Back Rule applies. If the case is run anytime after January 1, 2019, Lawrence will be eligible for APTC/CSR effective the appropriate future month with 10-day NOA.

Lawrence’s income will be calculated for 12 months ($1502.51 x 12 = $18,030.12) which will be over 138% FPL monthly and over 100% FPL annually.

Chastinne Bubbly is currently receiving MAGI MC and has been working as a movie extra earning $250 paid weekly for the past two years. She reports a CIC on November 8, 2018. She started working as an Election Specialist at Voter Registration on October 1, 2018. She earns $5900 monthly. Chastinne also reported that she ended her job as a movie extra on September 7, 2018. In addition, the EW makes new entries for the new job (Voter Registration) information as follows:

Note: Because the change was not reported timely, the income will be entered the first of the month that the client reported the change.

• After the EW completes all other data entries in CalSAWS, as necessary and calls BRE, CalHEERS will grant APTC as of December 1, 2018. Chastinne’s monthly income is over 138% FPL ($5900/monthly) and her annual income is also over 100% due to her new job.
  • Election Specialist ($5900 x 2 months = $11,800/annually)
  • Movie Extra ($250/weekly x 4.33 = $1082.50/monthly x 9 months = $9,742.50/annually).

Since her total annual income in 2018 is $21,542.50, CalHEERS will grant her APTC/CSR immediately, because the Bounce Back Rule does not apply.