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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Louisiana Last updated: 10/30/2019 Section A. Verification Procedures for Factors of Eligibility 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 Income* NO YES YES Both are above, at or below the applicable income standard. Percent Threshold 10% YES YES Louisiana verifies self-attested income through the Federal Hub data. If individual self-attestation of income and the data match are both below the Medicaid/CHIP MAGI eligibility level, individual will be determined eligible for Medicaid/CHIP benefits. If individual self-attestation of income and data match are both above the Medicaid/CHIP MAGI eligibility level, individual will be determined ineligible and account transferred to FFM for APTC eligibility. If individual self-attestation of income is above Medicaid/CHIP MAGI level, but data match puts applicant below the Medicaid/CHIP MAGI eligibility level, individual will be determined ineligible and account transferred to FFM for APTC eligibility. If there is no database source available, self-attestation will be accepted. Self-employment income will be verified if reported income is below the Medicaid/CHIP MAGI eligibility level. If individual self-attestation of income is below the Medicaid/CHIP MAGI level, but data match puts applicant above the Medicaid/CHIP MAGI eligibility level, reasonable compatibility level of 10 percent will be applied. If less than 10 percent difference, data is considered reasonably compatible and individual will be determined eligible for Medicaid/CHIP benefits. If there is more than a 10 percent difference and individual can provide a reasonable explanation/paper documentation (either already indicated on the application, or after formal request from the state), the individual will be determined eligible for Medicaid/CHIP benefits If there is more than a 10 percent difference and individual cannot provide a reasonable explanation/paper documentation, the individual will be determined ineligible for Medicaid/CHIP benefits the account transferred to FFM for APTC eligibility. Residency YES NO NO N/A N/A NO NO For the majority of cases, Louisiana will accept self-attestation. If a discrepancy that effects eligibility is discovered as a result of routine system checks for other eligibility factors (i.e. income), clear issue first with request for a reasonable explanation. Paper documentation would be last resort. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1