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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: California Effective Date: (mm/dd/yyyy) 7/11/23 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) DHCS Comments Income* Both are above, at or below the applicable income standard. 20% until May 2024 10% as of June 2024 YES YES Reasonable Explanation: Effective July 2022, California will allow an individual to provide a statement which reasonably explains the discrepancy, prior to the use of paper documentation. The state will developed a form for counties to use at application, renewal or a change in circumstance to assist with gathering the reasonable explanation. In instances when reasonable explanation is not viable or cannot be obtained, paper verifications will be requested. • If more than 20%/10% difference in reasonable compatibility and the individual can provide a reasonable explanation/paper documentation, the individual will be determined eligible for Medicaid/CHIP benefits. • If more than 20%/10% difference in reasonable compatibility and the individual cannot provide a reasonable explanation/paper documentation, the individual will be determined ineligible for Medicaid/CHIP benefits account transferred to CalHEERS for other IAP review. •For additional information on the description of the reasonable explanation implementation process, please refer to the Additional Comments tab. Reasonable Compatibility •If an individual attests to income below the MAGI eligibility group standard and the data match is above the standard, then the threshold of 20%/10% is applied. •If both the attested income and the data match are at/below the MAGI eligibility group standard then the amounts are reasonably compatible. The 20%/10% threshold amount is not needed and the individual is determined eligible. •If both the attested income and the data match are above the MAGI eligibility standard then the amounts are reasonably compatible, no threshold is needed, and the individual is determined ineligible and sent to the exchange for coverage. •If the individual attests to income over the eligibility standard and the data match is below, then the 20%/10% threshold is not applied in this circumstance and the individual is determined ineligible and sent directly to the exchange for coverage. •The reasonable compatibility 20% threshold will be applied starting in July 2022 NO YES YES Other (Specify in Comments) Residency CA is using the California Healthcare Eligibility and Enrollment Retention System (CalHEERS) to electronically verify residency. If residency can not be verified through CalHEERS, the State will accept attestation of residing in California without seeking paper documentation from individual. The CalHEERS system is interfaced with the Medi-Cal Eligibility Data System (MEDS) and Franchise Tax Board (FTB). If CalHEERS successfully uses MEDS (SNAP, TANF and Medicaid) enrollment data or FTB data to electronically verify residency CalHEERS will set the residency verification flag to "e-verified" and continue to process the application. If CalHEERS cannot electronically verify residency, CalHEERS will set the residency verification flag to "not verified" and continue to process the application without requiring the applicant to provide paper verification of residency. YES NO YES N/A N/A NO NO Age (Date of The state verifies this information with the federal Social Security Administration (SSA) when verifying social security numbers. If Birth) the State finds an inconsistency with SSA data, then State will request paper documentation from individual. NO NO YES N/A N/A NO YES Social Security Number ** NO NO YES N/A N/A N/A YES An electronic request for verification of the Social Security Number for each individual will be made prior to a request for paper documentation. Citizenship ** NO NO YES N/A N/A N/A YES An electronic request for verification of the citizenship will be made prior to a request for paper documentation. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 2