Page 3

MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: California Effective Date: 7/11/2 Secti Financial: 3 on B1. Use of Electronic Data Sources Electronic Data Source Determined Useful (Y/N) Accuracy Considered (Y/N) Timeliness Considered (Y/N) Ability to Access Considered (Y/N) Age of Data Considered (Y/N) Comprehensive Considered (Y/N) Other Criteria Used (Y/N) (Please Describe in Comments section) Data Source Used at Application (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollment (Y/N) If Data Source Used for Post- Enrollment - Frequency Used (e.g. monthly, quarterly) Comments 1. Internal Revenue Service (IRS) YES YES YES YES YES YES NO YES YES NO IRS data through the Hub will be used at application and renewal. The State understands that to use IRS data at renewal, individual must consent to use of that data. The application will have as a standard question if the individual wishes to provide such consent. 2. Social Security Administration (SSA) (SSI, Title II) YES YES YES YES YES YES NO YES YES YES SSA data through the Hub will be used at application and renewal. 3. State Wage Information Collection Agency (SWICA) YES YES YES YES YES YES NO YES YES YES Other (specify in comments) This information is provided quarterly via Recipient IEVS reports which will also be leveraged by CalHEERS interfaces with EDD. 4. State Unemployment Compensation YES YES YES YES YES YES NO YES YES YES Other (specify in comments) This information is provided monthly via Recipient IEVS reports which will also be leveraged by CalHEERS interfaces with EDD. 5. State Administered Supplementary Payment Program NO NO NO NO NO NO YES NO NO NO SSA administers this program for California 6. State General Assistance Programs NO YES NO NO YES YES NO NO NO NO Useful if made available in real-time; today, the State does not have established interfaces with the General Assistance programs. 7. Supplemental Nutrition Assistance Program (SNAP) NO YES NO NO YES YES NO NO NO NO Useful if made available in real-time; today, the State does not have any interfaces in real-time with SNAP. 8. Temporary Assistance for Needy Families (TANF) NO YES NO NO YES YES NO NO NO NO Useful if made available in real-time; today, the State does not have any interfaces in real-time with TANF. 9. Office of Child Support Enforcement (OCSE) NO YES NO NO YES YES NO NO NO NO Useful if made available in real-time; wage data is not stored, therefore, this data source would not be useful. Today, the State does not have any interfaces with OSCE. 10. State Income Tax YES YES YES YES YES YES NO YES YES NO State income tax data will be used at application and renewal. 11. Commercial database: (Pease describe any commercial databases in the space below) MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B1 - Use of Electronic Data Sources, Financial 4