Page 8

MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Connecticut Last update 11/08/2016 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 1. Social Security Administration (SSA) YES YES YES NO NO YES NO NO NO YES YES NO YES YES YES Other (specify in comments) Daily matches used post enrollment to identify any changes related to Medicare, and application for other benefits. Only used at renewal for these specific factors as well. SSN, citizenship and age/DOB will not be reverifed after application. Can also be used to resolve inconsistencies related to residency 2. Department of Homeland Security (DHS) - SAVE Other (specify in comments) Connecticut uses the Hub for step 1. After Step 1 fails we automatically trigger a notice for additional documentation and start a 90-day reasonable opportunity period. Utlized at renewal and post-enrollment - if individual has met the 5-year bar or if immigration status is subject to change or expire. YES NO NO YES NO YES NO NO NO NO NO NO YES YES YES 3. Vital Statistics NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO The Department of Vital Statistics information is not available for matches. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 8