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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Connecticut Last updated 11/08/2016 Section C . Additional Factors of Eligibility for Separate CHIP Eligibility Factor Self- Attestation Accepted without Additional Verification Self- Attestation Accepted with Post- Enrollment Verification Electronic Data Source Used (Y/N) If Yes, please describe in comments Paper Documentation Required from the Individual (Y/N) Non- Applicable (N/A) Comments 1. Applicant does not have other coverage NO YES NO NO Must be Applied Self-attestation is being accepted at time of application. Post eligibility periodic data matches are being used at other times. CT is planning to use a third party liability/other insurance contractor to identify enrollment in health insurance. Post enrollment verification is scheduled to be implemented in our ImpaCT system. Pilot is scheduled for October 2016. Statewide rollout is anticipated by Spring 2017. 2. Applicant does not have access to affordable ESI YES NO NO NO 3. When child has had coverage (as applicable to states' waiting period) N/A State no longer has a waiting period. 4. Access to public employee coverage YES NO NO NO N/A State does not cover children of state employees with title XXI funds. 5a. Waiting period exception #1 (describe): N/A 5b. Waiting period exception #2 (describe): N/A 5c. Waiting period exception #3 (describe): N/A 5d. Waiting period exception #4 (describe): N/A 5e. Waiting period exception #5 (describe): N/A 5f. Waiting period exception #6 (describe): N/A 5g. Waiting period exception #7 (describe): N/A 5h. Waiting period exception #8 (describe): N/A MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 11