Determining Overpayment Period

If an applicant, or a person acting on his/her behalf, fails to provide information or provides incorrect information on the “Statement of Facts” form at the time of application and eligibility was approved, the overpayment period begins with the first month eligibility was erroneously approved.

If an applicant, or a person acting on his/her behalf, fails to report a change in circumstances, income, or property (Non-MAGI MC Program only) timely (i.e., within ten days) and it results in an increased SOC determination or ineligibility, calculate the potential MC overpayment period as follows:

Exclude the month the change occurred.
Count the number of days between the date the change occurred through the end of the month to establish whether a 10-day notice could have been given.
The first month of the potential overpayment period will vary depending on the requirement to give a ten day notice prior to adverse action. (See the following example).

Note: The client may have monthly income that is over the Current Monthly Income (CMI) for MAGI but if the Projected Annual Income is less than the MAGI Limit the client will not receive an overpayment.

Overpayment Examples

Example 1Example 1

Kane Lomas has monthly income of $200 and is currently receiving MAGI MC; his total annual income is $2,400 ($200 x12 months). In December 2017, the EW discovers that Mr. Lomas started working in June 2016 and receiving $1,200 monthly from the Panda Art Gallery. The total unreported income in 2016 is $8,400 ($1,200 x 7 months) and in 2017 is $14,400 ($1,200 x 12 months).

In 2016:
The monthly income is over 138% FPL ($200 + $1,200 = $1,400/monthly). His new 2016 annual income is $10,800 ($8,400 + $2,400).

In 2017:
Mr. Lomas’ annual income was $16,800 ($1,400 x 12 months), which is over 100% FPL annually and over 138% FPL monthly, he was eligible for APTC in January 2017.

Although there was unreported income in 2016, due to the Bounce Back Rule there was no potential for an overpayment, Mr. Lomas remained MAGI MC eligible.

An overpayment must be established for 2017 because the unreported income was not subject to the Bounce Back Rule.

Example 2Example 2

Mrs. Litehart returned to work on June 20th but failed to notify the county until September 29.

Mrs. Litehart - Wages
June *	July **	August	September	October
6/20 Returns to work 10-day notice could not be issued in time to be effective in July			9/29 EW Notified
		OP	OP	OP
* No overpayment exists in June, since timely notice could not be issued. ** No overpayment exists in July because a notice of action to increase the SOC must be issued 10 days before the effective date of the action (excluding the mailing date). A potential overpayment exists for August, September and October.

Determining Overpayment Period

Overpayment Examples

Related Topics