Page 8

Section D. Additional Verification Questions Question Response 1

If paper documentation is required when a data source is not available or the information obtained from a

data source is not reasonably compatible with the

information provided by or on behalf of the individual,

briefly describe how the state determined that

establishing and using an electronic data source was

not effective, considering such factors as cost and

program integrity in accordance with 42 CFR 435.952(c): California accepts self-attestation for select application data elements. For those application data elements where California does not accept self-attestation, California will use an electronic data source

to verify, to the extent that there is a comprehensive, timely, accurate, cost effective data source readily available. If an electronic data source is not available or electronic verification is not reasonably

compatible with self-attestation, then California will first begin by initiateing administrative verification

process which will include a search of the databases of the local county consortia systems. If information

cannot be obtained through the search of databases, California will then seek additional information

from the individual including a statement which reasonably explains the discrepancy, prior to the use of

paper documentation. All available electronic/online data sources will be used prior to requesting paper documentation from the individual.

California plans to use multiple backup data sources (i.e. DMV, SNAP, TANF, State Income Tax, and PARIS can be used to verify residency).

The California Department of Public Health (CDPH) vital statistics interface with the Medi-Cal Eligibility Data System (MEDS) can be used as a backup data source to verify citizenship. It is also used to ensure

that Medi-Cal benefits are not issued to individuals who are using the Social Security numbers of deceased persons.

Please describe how the state uses PARIS?

a) PARIS Interstate - The PARIS Interstate match allows states to compare their beneficiary information with other states.

California receives approximately 60,000 matches per quarter and does not have the staffing resources to process this volume.

California does filter the quarterly match based on certain risk factors.

DHCS places the highest priority on individuals that match in multiple states and on outbound cases (someone leaving California).

It is DHCS’ objective to avoid improper payments for individuals that no longer meet the California residency requirement.

DHCS focuses on individuals that have moved away and have signed up for public assistance in another state.

Therefore, DHCS does not place a high priority on inbound cases, which are situations where the individual recently moved into California. These are considered low risk because county eligibility workers have just verified residency during the application process and because the other state needs to act on the PARIS match by disenrolling the individual from their public assistance program. DHCS sends residency verification letters to the individuals with the highest risk factors based on the PARIS match.

If the individual is non-responsive or

confirms that they have left California, the beneficiaries are discontinued from California’s Medicaid 2

program. b) PARIS Veterans –

Using the PARIS Veterans data match, California identifies individuals that are eligible or likely to be eligible for veteran’s health care benefits.

In coordination with local county offices,

outreach is performed to encourage the identified individuals to utilize VA health benefits instead of Medicaid, resulting in a cost avoidance savings to the state.

c) Using the PARIS federal data match California identifies federal income and shares this information

with the counties, who then compare the federal income identified by PARIS to the reported income of beneficiaries to assess for unreported income. In addition, California uses data from the PARIS Federal data match to identify Medicaid beneficiaries with private health coverage and codes the eligibility database accordingly which may result in cost avoidance savings for the state. 3

Please indicate (YES) or (NO) if the State intends to

request Secretarial approval to solely use alternative

data sources for financial verification other than those NO listed in 42 CFR 435.948 (Numbers 1-8 in Section B-1).

If (YES), please submit a letter to CMS requesting such

approval describing how the the state meets the following requirements:

1) Reduces administrative costs and burdens on

both individuals and the State, 2) Maximizes accuracy and minimizes delay,

3) Meets the requirements related to

confidentiality,

disclosure, maintenance and use of information, and

4) Promotes coordination with other insurance

affordability programs. 4

Please indicate (YES) or (NO) if the State intends to request Secretarial approval to use a mechanism other

than the federal data services hub for information that NO is available through the hub.

If (YES), please submit a letter to CMS requesting such approval describing how the state meets the following requirements:

1) Reduces administrative costs and burdens on both individuals and the State,

2) Maximizes accuracy and minimizes delay,

3) Meets the requirements related to

confidentiality,

disclosure, maintenance and use of information, and

4) Promotes coordination with other insurance

affordability programs. MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: California Effective Date: (mm/dd/yyyy) 7/11/23 MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION D - Additional Verification Questions 9