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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Arizona Last updated 09/27/2015 Section C . Additional Factors of Eligibility for Separate CHIP Eligibility Factor Self- Attestation Accepted without Additional Verification Self- Attestation Accepted with Post- Enrollment Verification (Y/N) Electronic Data Source Used (Y/N) If Yes, please describe in comments Paper Documentation Required from the Individual (Y/N) Non-Applicable (N/A) Comments 1. Applicant does not have other coverage NO NO YES YES Must be Applied Arizona will use its TPL Contractor to verify health insurance enrollment. Paper documentation will be required only if needed and can't be verified by the TPL Contractor. The contractor will be called directly to resolve and only in rare instances paper documentation is needed. 2. Applicant does not have access to affordable ESI NO NO NO NO N/A 3. When child has had coverage (as applicable to states' waiting period) NO NO YES YES Arizona will use its TPL Contractor to verify health insurance termintion date. Paper documentation will be required only if needed and can't be verified by the TPL Contractor. The contractor will be called directly to resolve and only in rare instances paper documentation is needed. 4. Access to public employee coverage NO NO NO NO Request verification only if questionable such as state employment identified by The Work Number. 5a. Waiting period exception #1 (describe): NO NO YES YES Involuntary termination of employment. Arizona will verify this electronically through The Work Number, SWICA and UI. Non-electronic verification will be required only if electronic verification is not available; for example, lost employment in another state MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 11