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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 Other (Identity) NO YES YES N/A N/A NO YES Using SSA to obtain both citizenship and identity. If information is incosistent with SSA and identity needs to be verified as part of citizenship, then identity would be verified separately through DMV (Mass RMV= registry of motor vehicles). Paper documentation will be requested only if those data sources are unavailable. 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. Other (Access to ESI) YES YES YES If applicant indicates working less than 32 hrs. per week, self attestation is accepted. If applicant indicates working 32 hours per week or more, an investigation is conducted regardless of applicant's response. N/A NO NO If state finds through electronic data sources that the individual has access to ESI and individual indicated that they don't have access, the agency will notify the individual. This applies to both Medicaid and CHIP. For Medicaid, it is to offer premium assistance if cost effective. For CHIP, it is to require enrollment in a qualified health plan. Other (Incarceration) NO NO YES N/A N/A YES NO Utilizing the HUB for incarceration status and also uses SVES Mass doesn't currently exercise option to suspend but only pay for services under certain circumstances. In the case where an applicant self attests they are not incarcerated but the HUB indicates they are incarcerated, Medicaid will ask the applicant for a paper verfication. 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. Other (Third Party Recovery) NO YES YES N/A N/A NO YES Data source matching occurs to identify individuals that haven't self-identified. Paper documentation is only required when an individual indicates that they've been injured. * States must check electronic data sources determined useful to verify income in accordance with 42 CFR 435.948 but can be done post-enrollment. If the information obtained from electronic data sources and the information provided by or on behalf of the individual are both above, at or below the applicable income standard, the State must determine the applicant eligible or ineligible for Medicaid/CHIP. (NOTE: this option is prepopulated for the state and is not an option that can be changed). ** States must follow statute, regulations, and guidance for verification of SSN, citizenship and immigration status including obtaining such information through the federal data services hub if available. *** States must accept self-attestation of pregnancy unless they have information that is not reasonably compatible with such attestation. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 3