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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 Age (Date of Birth) NO YES YES N/A N/A YES YES If data match comes back with an inconsistent age then Massachusetts does follow up through an outreach call to applicant to ask for paper documentation. This will not hold up eligibility determination or result in termination if the individual does not respond. For age, Massachusetts receives verification of a SSN from SSA via the FDSH. Part of the SSN verification includes confirmation of name and DOB. FDSH (SSA) will be used at application. Social Security Number ** NO NO YES N/A N/A N/A YES 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. Citizenship ** NO NO YES N/A N/A N/A YES Massachusetts will follow statute, regulations, and guidance for SSN, citizenship and immigration status including obtaining such information through the federal data hub services if available. 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. Immigration Status ** NO NO YES N/A N/A N/A YES Massachusetts will follow statute, regulations, and guidance for SSN, citizenship and immigration status including obtaining such information through the federal data hub services if available 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. Household Composition YES NO NO N/A N/A NO NO Pregnancy *** YES NO NO N/A N/A NO NO Caretaker Relative YES NO NO N/A N/A NO NO Medicare NO NO YES N/A N/A NO YES Application for Other Benefits YES NO NO N/A N/A NO NO Other: (Please describe any other eligibility factors in the space below) MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 2