MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1 MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Colorado Section A. Verification Procedures for Factors of Eligibility Self- Self- Eligibility Factor Attestation Accepted without Additional Verification (Y/N) 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) Comments Income* NO YES YES Both are above, at or below the applicable income standard. Percent Threshold 10% YES YES Attested income will be verified through IEVS via post-eligibility. Paper documentation will only be required if self attested income does not meet the standard for reasonable compatibility, AND if the attestation does not meet the standard for a reasonable explanation. The Department has chosen to set its reasonable compatibility threshold at 10% in order to align its policies with those of Connect for Health Colorado, to maintain comparable patterns in eligibility changes experienced under IEVS, and to achieve budget neutrality while remaining within its current legislative authority. If the individual attests to income below the applicable income standard, and the data source indicates income above the applicable standard, and the difference between the two is greater than 10% then a reasonable explanation or paper documentation will be requested. When an individual attests to income above the applicable standard and data source indicates income below the standard, the state will take the attestation and make the person ineligible and send to Connect for Health Colorado (exchange) for APTC. Additional information will not be requested. Verification of income will occur between 2-4months after a determination has been made. Further detail documented in Additional Comments. The Department also expects to continue to analyze the impact of different reasonable compatibility thresholds, and may work to increase the threshold as more data becomes available. The IEVS system is used to verify earned income, unearned income, and unemployment. Residency YES NO NO N/A N/A NO NO Age (Date of Birth) YES NO NO N/A N/A NO NO Social Security Number ** NO NO YES N/A N/A N/A YES Colorado plans to utilize their internal SSA feed (not the Hub) at application to verify SSN because it is real-time. If not verifiable by the electronic source or if questionable (i.e. duplicate SSN found within the system), paper documentation will be requested. Exception for an individual who is not eligible to receive a SSN or refuses to obtain a SSN because of a religious objection. Citizenship ** NO NO YES N/A N/A N/A YES If citizenship cannot be verified through internal SSA feed, individual will be enrolled within Medicaid or CHIP and be provided a 90 day reasonable opportunity to provide documentation. The reasonable opportunity period will be extended if individual is making a good faith effort to obtain documentation. If identity needs to be verified as part of citizenship the state can use electronic data from the DMV before asking for paper documentation. Immigration Status ** NO NO YES N/A N/A N/A YES Obtained through the Hub. Only request paper documentation if not verifiable by electronic source or if it is questionable, i.e. such as immigration number and another individual within the system has the same number. Household Composition YES NO NO N/A N/A NO NO Pregnancy *** YES NO NO N/A N/A NO NO Caretaker Relative YES NO NO N/A N/A NO NO Medicare YES NO NO N/A N/A NO NO Application for Other Benefits YES NO NO N/A N/A NO NO Other: (Please describe any other eligibility factors in the space below) * 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.