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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 Citizenship ** NO NO YES N/A N/A N/A YES Paper documentation is requested if data source is not compatible with what the individual attestests on the application. Immigration Status ** NO NO YES N/A N/A N/A YES Paper documentation is requested if data source is not compatible with what the individual attests on the application. Household Composition YES NO NO N/A N/A YES YES For pregnant individuals, paper documentation is requested when individual attests to expecting greater than 3 children. Paper documentation required only when reasonable explanation does not clarify discrepancy that would impact eligibility. Pregnancy *** YES NO NO N/A N/A NO NO Caretaker Relative YES NO NO N/A N/A YES YES Paper documentation required only when reasonable explanation does not clarify discrepancy that would impact eligibility. Medicare NO YES YES N/A N/A YES YES Paper documentation required only when reasonable explanation does not clarify discrepancy. Application for Other Benefits NO YES YES N/A N/A YES YES Paper documentation required only when reasonable explanation does not clarify discrepancy that would impact eligibility. Other: (Please describe any other eligibility factors in the space below) MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 3