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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 6. Supplemental Nutrition Assistance Program (SNAP) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Not available 7. Office of Child Support Enforcement NO NO NO NO NO NO NO NO NO NO NO NO NO NO YES For medical support identification. Not implemented due to difficulty for CSEA to receive multiple files. 8. State General Assistance Programs NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Not available 9. Women, Infants and Children Program (WIC) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Not available 10. State Income Tax NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Not available 11. Commercial database: (Please describe any commercial databases in the space below) Third party coverage YES NO NO NO NO NO NO NO NO NO NO YES YES YES YES Quarterly Effective from 1/1/14 to identify other commercial health insurance coverage. This is CHIP specific at application, renewal and post- enrollment. For Medicaid, third party coverage does not affect eligibility so checks are done post-enrollment. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 8