Page 1

MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Arizona Last updated 09/27/2016 Section A. Verification Procedures for Factors of Eligibility Eligibility Factor Self- Attestation Accepted without Additional Verification (Y/N) Self- Attestation Accepted with Post-Eligibility Verification (Y/N) Electronic Data Source Used (Y/N) Reasonable Compatibility Standard Used Specify Reasonable Compatibility Standard for Income Ask for a Reasonable Explanation from the Individual (Y/N) Paper Documentation Required from the Individual (Y/N) Comments Income* NO NO YES Both are above, at or below the applicable income standard. Other (Specify in Comments) N/A YES YES If the individual attests to income below the applicable standard, but the data sources indicate income above the applicable standard, a reasonable explanation/paper documentation will be requested. If the individual attests to income above the applicable standard and data source indicates income below the standard, accept the customer's attestation and screen for APTC. State will utilize the Federal Data Service Hub (FDSH) for some income but not the IRS. For additional information, see "Additional Comments 1" for in depth inforamtion on Health-e-Arizona Plus Application Questions to Clarify Income Inconsistencies. Residency NO NO YES N/A N/A NO YES Request documentation if residency cannot be verified electronically Age (Date of Birth) NO NO YES N/A N/A NO YES Verify age only when there is a discrepancy that affects eligibility between electronic data from the Federal hub, State hub and State Eligiblity Determination Systems and the attestation. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1