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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Massachusetts 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% NO YES If attested income is below the applicable standard and the data source indicates income above the applicable standard, but the difference is 10% or less the state considers that reasonable compatible. If the difference is more than 10% than will request paper documentation.

When an individual attests to income above the applicable Medicaid/CHIP standard, putting them into an APTC range, but data sources indicate the income is lower and within a Medicaid/CHIP range, the state determines the person ineligible for Medicaid/CHIP and continues the process to make a determination for APTC. Further information is not requested unless it is needed for the APTC determination. FDSH (IRS/SSA), Department of Revenue and Department of Workforce Development (DWD) will be used at application. Inconistencies will be resolved through additional verificaiton post-enrollment as authorized under the state's 1115 waiver. If post enrollment verification is required, the individual will be requested to submit paper verification. As authorized under Section 1902(e)(14)(A)of the Act, MA received approval from CMS on March 31, 2014 to extend the Provisional Eligibility period for applicants with verification inconsistencies an additional 90 days. This authority applies to provisional coverage for individuals who apply for coverage by June 30, 2014. Residency NO YES YES N/A N/A NO YES Data source checks that the address is a real residential address. If not, then additional verification is required. Data source will also check for additional associations with the address to gain additional confidence in the individual's association with the address. If low confidence, additional information and paper documentation will be requested. Note: Certain exceptions will apply (i.e Nursing Homes) Exception: Self-attestation without additional verification is accepted if the individual indicates that they are homeless. Experian/Lexis Nexis will be used at application. Inconistencies will be resolved through additional verificaiton post-enrollment as authorized under the state's 1115 waiver. As authorized under Section 1902(e)(14)(A)of the Act, MA recieved approval from CMS on March 31, 2014 to extened the Provisional Eligiblity period for applicants with verification inconsistencies an additional 90 days. In addition, the state has recieved authority to extend the Provisional Eligiblity period for individuals who apply for coverage by June 30, 2014. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1