P607 How to Process Expenses Exceed Income

MA607

Go to the “Household Has No Income” or “Household Expenses Are More Than Income” page in HEAplus. Has the customer already answered the questions about how living expenses are being met?

• If YES, continue to step 2.

• If NO, ask how the customer is paying the expenses. Enter the information on the Household Has No Income or Household Expenses Are More Than Income page. Select all options that apply. Continue to step 2.

NOTE     Make sure that the information provided explains how all the expenses are being met. For example, a one-time gift of $200.00 does not explain how expenses are being met for a household of 4. Enter case notes if the circumstances are expected to change and follow up for any changes that would affect eligibility.

Is the customer living with family and friends?

• If YES, review the relationship and tax filing status to see if it affects the budget group of the customer. Continue to step 3.

• If NO, continue to step 3.

When the customer is meeting living expenses in one or more of the following ways, enter all available information and discuss any questionable or inconsistent information with the customer:

• Using money from checking or savings accounts

• Living off credit cards

• Getting loans from people

NOTE     Loans are not income. However, if the customer is the lender, any interest payments received are countable income for MAGI and must be entered as income. Continue to step 4.

When the customer is meeting living expenses in one or more of the following ways, go to the income batteries and enter the income:

• If the customer selected “Someone is giving you or any persons living with you money”, go to the “other income types” battery and enter the income as “gifts”.

• If the customer selected “Working in exchange for rent”, go to the “other income types” battery and enter the information as “In Kind income”.

• Working “odd jobs” – Enter the income as “Earnings from job (wages)”.

Continue to step 5.

When the customer has an explanation that does not match any of the available selections, check “Other” and enter the explanation in the text box. If the customer already chose “Other”, make sure the explanation describes how the expenses are being met and ask follow up questions as needed. Enter any additional information or explanation in the case notes.

Did the customer fail to provide any explanation of how living expenses are met, or is the explanation inconsistent or questionable?

• If YES, skip the page without checking any boxes. HEAplus will add language to the RFI asking how living expenses are being met. If information was already entered but is questionable, manually add the RFI factor requesting the additional information. Continue to step 7.

• If NO, STOP. EEI is resolved. Process the case. Make any additional case notes as needed.

Did the customer provide the requested information?

• If YES, EEI is resolved. Process the case. Make any additional case notes needed.

• If NO, deny or discontinue the application for failure to provide information needed to determine eligibility.

Ask how living expenses are being met. Select all options that apply, on the No Income page or Expenses Exceed Income (EEI) page.

NOTE    Do not skip this page. If skipped, HEAplus will default to “Living off credit cards”.

When the customer is meeting living expenses in one or more of the following ways, discuss any discrepancies with the customer:

• Living off credit cards
• Getting loans from people

NOTE     HEAplus will generate a link “go to income” when “Getting loans from people” is selected. Loans that are money borrowed by the customer are not income. If the customer made loans to others, it needs to be explored as a resource and if the customer is receiving loan payments, the interest portion of the payment is excluded income for non-MAGI programs.

Continue to step 3.

When the customer is meeting living expenses using money from checking or savings accounts, select the link “go to resources” that is generated with this selection. Review the financial accounts that support the customer’s statement and determine if additional proof is needed.

When the customer is meeting living expenses through one or more of the following, select that option then click the link “go to income” and enter the income in the “Other Income” section:

• Someone is giving you or any persons living with you money – income type is “Gifts”
• Working in exchange for rent - income type is “In Kind”
• Working “odd jobs” – income type is “Earnings from job (wages) or Self-employment”

Continue to step 5.

Important! One of the page options does not accurately reflect its intent and should be handled as follows:

• When someone is paying the customer’s bills directly, select “Someone is gifting money to pay expenses/bills”. Enter the additional information explaining which bills are paid.
• Do not use this option when someone is giving money directly to the customer’s household regardless of the reason. See step 4 for all gifts.

NOTE     When this is the only entry on the page, HEAplus will generate an error message. Select any other options that apply.

The customer’s explanation for how expenses are being met may not match any of the choices on the EEI and No Income pages.

When this happens, document the actual details of the customer’s explanation in case notes and select “Living off Credit Cards”.

NOTE     When the customer does not yet know how expenses will be met, accept their statement. Place a reminder on your calendar for follow up in 6 months.

Review the customer’s explanation and any documents in the file that may support the customer’s statement. Did the customer fail to provide any explanation of how living expenses are met, or provide an explanation that is inconsistent or questionable?

• If YES, continue to step 8.
• If NO, STOP. HEAplus will generate any RFIs needed for any added income, but no further proof is needed for how the customer’s expenses are being met.

When the customer refuses to provide an explanation, or the explanation is inconsistent with other information or is questionable, manually add the EEI or No Income factor to the RFI.

Did the customer provide proof that shows how expenses are being met or that they are not being paid?

• If YES, EEI is resolved. Process the case. Make any additional case notes needed.
• If NO, deny or discontinue eligibility for failure to provide information needed to determine eligibility.