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Electronic Data Source To Be Used (Y/N) Social Security Number Citizenship Immigration Status Residency Age/DOB Pregnancy Household Composition Caretaker Relative Medicare Application for other Benefits Other Data Source Used at Applicatio n (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollme nt (Y/N) If Used for Post- Enrollment Frequency Used (i.e. monthly, quarterly) Comments 6. Supplemental Nutrition Assistance Program (SNAP) YES YES YES YES NO NO NO NO NO NO NO NO YES YES YES Other (specify in comments) Check at application, recertification and report of change only if there is a discrepancy in state eligibility database. Only used at renewal/post enrollment if there's been a change in immigrations status or 5 yr. bar. Only use for SSN if verified with SSA first. Only use for citizenship and immigration status if verified in accordance with Medicaid/CHIP rules. 7. Office of Child Support Enforcement YES NO NO NO NO NO NO NO NO NO NO YES NO NO YES Other (specify in comments) Medical child support and paternity cooperation post enrollment.

Can also be used if discrepancy found through independent report from TPL. 8. State General Assistance Programs NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO N/A 9. Women, Infants and Children Program (WIC) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO N/A MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 8