Projected Annual Income

For income that fluctuates month to month, the SSApp specifically asks for the PAI. CalHEERS also asks for PAI information and e-verifies PAI and CMI separately.

PAI is not required for a MC eligibility determination and benefits should never be denied or discontinued for failure to provide PAI verification.

Note: PAI will not be counted in the CalSAWS budget for Non-MAGI MC or any other program. [Refer to Job Aid (JA) - Income Categories and Types in the System]

How CalHEERS E-Verifies PAI and CMI

CalHEERS calculates a monthly income amount from the PAI for comparison purposes. CalHEERS will always use the lower of the two monthly amounts to determine eligibility when both have been e-verified. If the lower amount is e-verified, it will e-verify the higher amount as well.

If...	Then...
Both amounts are e-verified,	CalHEERS will use the lower amount for eligibility.
The lower amount is e-verified,	CalHEERS will use the lower amount for eligibility and automatically e-verify the higher amount so eligibility does not pend.
The higher amount is e-verified,	CalHEERS may not e-verify the lower amount and verification may need to be requested.

When to Enter PAI

PAI is only entered for individuals who attest to PAI that is more beneficial than their CMI.

Examples of when PAI is used:

When PAI is below the MAGI limit and CMI is above the MAGI limit.
When both PAI and CMI are under the MAGI limit, but the CMI makes a child eligible to a premium aid code and the PAI makes the child eligible to a non-premium aid code.
When PAI and CMI are both above the MAGI limit, and PAI is lower than CMI.

CMI must continue to be entered in the appropriate income-related windows, even when PAI is entered in CalSAWS. Because PAI is used as a last resort, it should not be entered until it has been verified.

When to Request Verification

When a client reports PAI and CMI, verification is not necessarily required for both. Follow the table below for requesting verification.

If...	And...	Then...	Exception
Both amounts are within the MAGI limit,	One or both are e-verified,	No further verification is required.	If the unverified amount would qualify a child for a non-premium aid code and the e-verified amount qualifies a child for a premium aid code, request verification of the lower amount.
Both amounts are within the MAGI limit,	Neither is e-verified,	Request verification of CMI.
One amount is over MAGI, one amount is below,	Only the amount above MAGI is e-verified,	Request verification of the amount below MAGI to see if the client is MAGI eligible.
One amount is over MAGI, one amount is below,	Only the amount below MAGI is e-verified,	No further verification is required.
Both amounts are over MAGI (mixed households),	One or both are e-verified,	No further verification is required.
Both amounts are over MAGI (mixed households),	Neither is e-verified,	Request verification of the lower amount.

Guidelines for Entering PAI

Never enter $0 PAI when the client has not attested to any PAI.
Never enter PAI for dependents or other household members when they do not have their own annual income. PAI is individual-based; adding incorrect PAI will cause the household income to increase.
When a PAI record is open and a client reports new CMI, but does not report PAI, the PAI should be end dated. A new record should only be opened when the client reports new PAI that is more beneficial to the client than CMI.

End Dating PAI

PAI should be end dated when an income change is reported.

Individuals With No PAI Who Are Pending Eligibility for PAI Verification

Individuals who have no PAI, but have household members that do, may pend for not having PAI verification. To grant those individuals eligibility, complete the following steps:

Log in to CalHEERS.
Enter the CalHEERS Case ID.
Select any individual from the appropriate case and click [Manual Verification].
Select the individual who is pending in CalSAWS to open the Personal Verification page.
On the Personal Verification page, scroll down to “MAGI Medi-Cal Projected Annual IncomeMAGI Medi-Cal Projected Annual Income”. The drop-down in the Verification Status column should say Pending.
Select Pass from the drop-down in the Verification Status column.
Click [Save].
Repeat Step 1 through 7 for any other household members who are pending for PAI but have no attested PAI.
On the Household Verifications page, click [Redetermine Eligibility]. This will send a CEW Through Portal Change DER to CalSAWS. Process the Change DER.
Once EDBC is run, the individual(s) should no longer be pending.

Note: THIS SHOULD NOT BE USED FOR ANY OTHER SCENARIO. If individuals do have PAI and are pending for PAI, the verification must be requested and processed as usual.