Income Verification

Earned Income

Earned income can be verified using:

E-Verification from the federal hub
One pay stub (most current pay stub available to the client; not required to have been issued within the last 30 days but must accurately reflect the amount reported on the application).
Copy of federal tax return that accurately reflects current income. For self employment, last years tax documents are sufficient. For all other income, the tax documents must have been filed within 90 days to be used as verification
Signed letter from employer showing the gross amount and date of paycheck
Receipts showing gross earnings and expenses
Business records (Profit and Loss Statements)

Earned income must be verified prior to approval and at redetermination, restoration or reapplication. If there is a discrepancy between the pay stub submitted and the amount reported on the application, the EW may request additional pay stubs to determine the correct monthly income.

If the client receives income and items listed above are not available, EW must obtain a “Sworn Statement” as a last resort. Any statement signed and dated under penalty of perjury is acceptable (e.g. SCD 101, GEN 853, Attestation of Income form from Covered CA, etc.).

Individuals Paid in Cash

Individuals who are paid in cash often cannot provide proof of income. If all other options are exhausted (i.e. attempt to get employer statement, verification through the Federal Hub, etc.), the signature on an application is sufficient verification of income for clients paid in cash. Additionally, clients can complete a Sworn Statement as verification.

The Work Number

The Work Number is not to be utilized to obtain verification of income for MC only cases. It may however be used for combo MC cases. Additionally, if an individual is on CalFresh in one case, and Medi-Cal in another, the Work Number may be used to verify income for the Medi-Cal only case.

ExampleExampleDaisy is on a CalFresh only case, because her and her roommate purchase and prepare food together, however, they file taxes separately, so Daisy is on her own Medi-Cal case. Because Daisy is active on both CalFresh and Medi-Cal (despite the fact that it is on two different cases) the Work Number can be used as verification on the Medi-Cal only case. Document the circumstances thoroughly CalSAWS.

Unearned Income

Unearned income can be verified using:

Award letter or most recent cost-of-living increase notice
IEVS/PVS abstract or printout
Current bank statement if the applicant has direct deposit or copy of the applicants current benefit check
- Note: The deposit or check may not reflect gross income if Medicare premiums are being deducted or an overpayment is being collected from the client’s check.
Signed statement from the person or organization providing the income.

If the client receives income and items listed above are not available, EW must obtain a “Sworn Statement” from the individual (as a last resort).

Unearned income must be verified prior to approval, and at each reapplication, restoration, or redetermination.

Using the Federal Hub to Verify Income

For a MAGI case, information from CalSAWS is sent to CalHEERS and matched against the Federal Data Services Hub (Federal Hub). Reported income that matches the federal hub within the allowable threshold will be “e-verified”. E-verification is only valid for MAGI MC and APTC and must not be used as verification for Non-MAGI or other programs. In a combo case (i.e. CalFresh/MC) other verification must be requested.

There are different E-Verification categories on the Manual Verification page in CalHEERS: Household Current Monthly Income (CMI), Projected Annual Income (PAI), and Household Income Subsidy (annual amount). E-Verification is at an individual level. The same amount of income may be E-Verified for one person, and not E-Verified for another. For any income category that is e-verified it is considered reasonably compatible. Further verification is not required if the amount is below the MAGI MC limit for that individual and no other conflicting information is found.

Further guidance on when additional verification may be required can be found in [MC HB: Projected Annual Income].

Reasonable Explanation for MAGI MC Income

The method of reasonable explanation is now included as part of the Medi-Cal eligibility verification process and allows the flexibility to request and accept a reasonable explanation to resolve income discrepancies for MAGI and Non-MAGI Medi-Cal at application and annual redeterminations. The reasonable explanation process will assist with the unwinding of the Covid-19 Public Health Emergency (PHE) and will continue after the PHE unwinding period has concluded.
For MAGI Medi-Cal, when income is not E-Verified from the Federal Data Services Hub (FDSH) or any electronic data source, the EW can provide the applicant or beneficiary an opportunity to explain the discrepancy that is consistent with current information found in the beneficiary’s file and that explains the difference.
Reasonable explanation guidance and examples can be found in [MCHB: Applications] and [MCHB: Redeterminations.]