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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) YES NO NO NO YES YES NO YES YES NO NO NO YES YES NO Louisiana has an approved State Plan amendment effective July 1, 2016, to use the SNAP option for the streamlined enrollment of SNAP recipients. Louisiana obtains all information necessary for a Medicaid eligibility determination that is not contained in the case record for SNAP. 7. Office of Child Support Enforcement (OCSE) YES NO NO NO NO NO NO NO NO NO NO YES NO NO YES Other (specify in comments) Non-cooperation occurs when the active enrollee fails to cooperate with OCSE in establishing paternity and in obtaining medical support and payments. A sanction suspends benefits of the parent/caretaker relative and can be imposed for non­ cooperation with OCSE. 8. State General Assistance Programs NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Program does not exist in Louisiana 9. Women, Infants and Children Program (WIC) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Not an electronic data source 10. State Income Tax NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Do not have access 11. Commercial database: (Please describe any commercial databases in the space below) HMS YES NO NO NO NO NO NO NO NO NO NO YES NO YES YES Other (specify in comments) Effective September 1, 2016, Louisiana has a contract approved with the vendor, HMS, to collect insurance information on active enrollees and to update MMIS and eligibility systems. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 8