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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 Immigration Status ** NO NO YES N/A N/A N/A YES California has implemented SAVE Steps 1, 2 and 3 for all applications that are processed through the CalHEERS access channel. CalHEERS will automatically initiate Step 2 when indicated, as the Hub VLP service no longer pushes to any step automatically (this has been the case since February 2019). If needed, a request can be made to CalHEERS to initiate Step 3 since such cases are already in process with DHS. Household Composition YES NO NO N/A N/A NO NO There is currently no data source which provides Household Composition data. Pregnancy *** YES NO NO N/A N/A NO YES Self-attestation is accepted unless the State finds information that is conflicting and may require follow-up with a request for paper documentation. Caretaker Relative YES NO NO N/A N/A NO NO Self-attestation is accepted for "caretakers" if the individual is providing care to a minor child; this is consistent with current policy. Medicare NO NO YES N/A N/A NO YES The Trusted Data Source for electronic verification of Medicare status is the Non-Employer Sponsored Insurance (Non-ESI) Minimal Essential Coverage (MEC) service provided by the Hub. An electronic request for verification of the Medicare Status for each individual will be made prior to a request for paper documentation. Application for Other Benefits YES NO NO N/A N/A NO NO Other: (Please describe any other eligibility factors in the space below) Deceased NO NO YES N/A N/A YES NO In cases where the State receives an erroneous death letter from SSA, the State will follow-up with a request for a reasonable explanation. American Indian/Alaska Native Status for Cost-Sharing Exemptions YES NO NO N/A N/A NO YES Self-attestation is accepted unless the State finds information that is conflicting and may require follow-up with a request for paper documentation. Former Foster Care and Medicaid Enrollment NO YES YES N/A N/A NO YES The State will accept self-attestation of an individuals enrollment in foster care and Medicaid upon obtaining age 18. Counties will verify this information post enrollment utilizing data from their county-based eligibility data systems or in the case of individuals attesting to enrollment in foster care outside of California, counties and/or the California Department of Social Services will contact the other state to confirm foster care placement and Medicaid enrollment. The Trusted Data Source for electronic verification of Medicaid status is the Non-Employer Sponsored Insurance (Non-ESI) Minimal Essential Coverage (MEC) service provided by the Hub. An electronic request for verification of the Medicaid Status for each individual will be made prior to a request for paper documentation. Medicaid verification via the Non-ESI MEC service is called at initial application and at annual renewal. * States must check electronic data sources determined useful to verify income in accordance with 42 CFR 435.948 but can be done post-enrollment. If the information obtained from electronic data sources and the information provided by or on behalf of the individual are both above, at or below the applicable income standard, the State must determine the applicant eligible or ineligible for Medicaid/CHIP. (NOTE: this option is prepopulated for the state and is not an option that can be changed). ** States must follow statute, regulations, and guidance for verification of SSN, citizenship and immigration status including obtaining such information through the federal data services hub if available. *** States must accept self-attestation of pregnancy unless they have information that is not reasonably compatible with such attestation. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 3