Reasonably Projected Annual Income

Reasonably Projected Annual Income (RPAI) is the total amount of income an applicant or beneficiary expects to receive in a twelve-month period, starting at the month of application, annual renewal, or reported change in circumstance. The RPAI budget period promotes continued coverage to those who would otherwise not qualify for MAGI MC because of their fluctuating monthly income.

When fluctuating income is reported that appears to be RPAI and there is sufficient evidence to determine the RPAI period, it may be used as a budget period.

Calculating RPAI

Beginning in September 2025, the calculation of RPAI is now automated in CalHEERS for individuals who attest to having fluctuating income for 12 months from the date of application, renewal, or change in circumstance. SSBS no longer need to calculate the RPAI manually. If an individual reports income that will fluctuate over the next 12 months, CalHEERS will automatically evaluate and determine whether the average monthly amount of the fluctuating income meets the FPL limit for the HH size and is less than the CMI.

To calculate the monthly RPAI, the SSBS shall divide the determined RPAI amount by twelve. The SSBS should then compare the individual's CMI amount to the RPAI amount and use whichever budget period has the lowest monthly income. Verification of RPAI is required if the self-attested income information is not reasonably compatible with the Federal Data Services Hub (FDSH). A sworn statement (either verbal or written) may be accepted as a last resort. If RPAI budgeting is used, MC beneficiaries must still report any future changes in income.

[Refer to CH Job Aid (JA) - Budget Worksheet] for further guidance.

Important: When using an RPAI budget period, SSBS should enter the RPAI amount as an annual entry of PAI.

Note: RPAI is terminology specific to MAGI MC. Due to policy differences and current system functionality, Covered CA will reference the MAGI MC RPAI as PAI.

ExampleExamplePerson A had income from employment in Jan, Feb, and March. They were laid off and filed for Unemployment (UIB) on April 1 then applied for MC on April 5. They provide verification of the amount of benefits available through the UIB claim, which was $8,600, and report that the benefits will be exhausted in September of the current year. Person A also provides the UIB award letter verifying their CMI of $1,755 per month. Based on the report of fluctuating income and proof of the income ending with the unemployment award letter, their income is considered reasonably predictable and the RPAI budget period may be applied. ($8,600 divided by 12 months=$716.66 per month RPAI).

ExampleExamplePerson B works as a lifeguard during spring and summer. They apply for MAGI MC on June 1, and state they have a CMI of $1,500, but also report they are a seasonal worker and only receive this income from April through September. From October through March, they receive no wages. Person A also states that they had the same schedule in the previous year and expects it will continue. They provide verification that the fluctuating income can be reasonably predicted so the RPAI budget may be applied. To determine the RPAI income, the SSBS multiplies their CMI of $1,500 by six months (the total months in which the income was received) and then divides that amount by twelve to obtain the RPAI. ($1,500x6=$9,000. $9,000 divided by 12 months=$750 per month RPAI).

Reasonably Projected Annual Income

Calculating RPAI

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