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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Connecticut Last update 11/08/2016 Section A. Verification Procedures for Factors of Eligibility 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) Comments Income YES YES YES Both are above, at or below the applicable income standard. Percent & Dollar Threshold The greater amount of 10% or $100 YES YES The state has implemented the use of state wage and unemployment income informtion from the CT. Department of Labor as the initial review of self attested income. The reasonable compatability standard of 10% or $100 is used (whichever is greater). Self-attested income may then be compared to IRS and Social Security income from the FDSH. Self- attested income is reasonably compatable if within the greater of 10% or $100. Connecticut recieved a waiver from CMS under section 1902(e)(14) of the Act to allow the state to determine eligibility based on self-attested amounts and provide a 90-day Reasonable Opportunity Period for the household to resolve inconsistencies on an interim basis. In the future, CT plans to implement earnings from the Work Number as an electronic data source. Self-attestation is accepted without verification when no electronic source is available (eg. alimony and self- employment income for non-filers). There is no estimated time of completion regarding the implementation of the Work Number. This has been removed from scope for 2015. Implementation of the Work Number has not yet been prioritized for 2016. Residency YES NO NO N/A N/A YES YES Paper documentation required only when reasonable explanation does not clarify discrepancy that would impact eligibility. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1