Page 7

MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Massachusetts Section B2. Use of Electronic Data Sources Non-Financial: 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 Applicatio n (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollme nt (Y/N) If Used for Post- Enrollment Frequency Used (i.e. monthly, quarterly) Comments 1. Social Security Administration (SSA) YES YES YES NO NO YES NO NO NO YES NO NO YES YES YES Monthly Post-enrollment, data source is checked monthly for any status changes related to Medicare 2. Department of Homeland Security (DHS) - SAVE YES NO NO YES NO NO NO NO NO NO NO NO YES YES NO We will data match for immigration status at the time of application, renewal, when a status is set to expire, and at least once every 12 months for members who have their MassHealth renewal date extended 3. Vital Statistics YES NO YES NO NO NO NO NO NO NO NO NO YES NO NO Mass can only check data source with permission. 4. Department of Motor Vehicles (DMV) YES NO NO NO NO NO NO NO NO NO NO YES NO NO YES Other (specify in comments) Identity Verification if needed as part of citizenship during the reasonable opportunity period MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 7