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Electronic Data Source To Be Used (Y/N) Social Security Number Citizenship Immigration Status Residency Age/DOB Pregnancy Household Composition Caretaker Relative Medicare Application for other Benefits Other Data Source Used at Application (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollment (Y/N) If Used for Post- Enrollment Frequency Used (i.e. monthly, quarterly) Comments 13. Other: (Please describe additional electronic data sources in the space provided below) Non-Employer Sponsored Insurance (Non-ESI) Minimal Essential Coverage (MEC NO NO NO NO NO NO NO NO NO YES NO NO YES YES NO 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. Medicare verification via the Non-ESI MEC service is called at initial application and at annual renewal. National Change of Address Database (NCOA) and United States Postal Services (USPS) In- State Forwarding Address NO NO NO NO YES NO NO NO NO NO NO NO NO YES YES Other (specify in comments) NCOA and USPS in-state forwarding address will be used to update in-state contact information confirmed by and received from the NCOA database or USPS returned mail with a forwarding address, when confirmed by the Medicaid beneficiary. USPS in-state forwarding address will be used when mail is returned as undeliverable by the state, when confirmed by the Medicaid beneficiary. * Under 42 CFR 435.945(d), all State Medicaid eligibility systems must conduct a match with PARIS for Interstate benefit information. If used for other purposes, please indicate in Section D. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 7