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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) 12. PARIS* YES NO NO NO NO NO NO NO NO NO NO YES NO NO YES Quarterly Connecticut receives a quarterly PARIS report indicating individuals that are receiving Medicaid benefits in other states. An evaluation is done and a determination is made to establish if an individual will maintain eligibility for Medicaid benefits in Connecticut. Can be used for residency verification if need be. State Department of Corrections (DOC) Match YES NO NO NO NO NO NO YES NO NO NO YES NO NO YES Monthly This is a electronic data match of convicted Connecticut residents that are in state correctional facilities. Connecticut's legacy eligibility system does not support Medicaid suspensions. As Connecticut must rely on our legacy system during the initial implementation of the Affordable Care Act, we must advise incarcerated individuals that they are not eligible for Medicaid. We understand that incarceration does not preclude medicaid eligibility for an individual--it only prohibits federal reimbursement for most services. Although our legacy eligibility system does not support Medicaid suspension, Connecticut has administrative processes that support the prompt provision of Medicaid coverage for individuals leaving public institutions, as well as to grant Medicaid for in-patient admissions, and process to provide long-term care benefits to DOC individuals being placed in a dedicated long-term care facility . It is our intent to continue this process until we are able to refine our current process, and will access our ability to support Medicaid suspensions with the development of our new integrated eligibility system. * 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 10