Page 2

Eligibility Factor Self- Attestation Accepted without Additional Verification (Y/N) Self- Attestatio n Accepted with Post- Eligibility Verificatio n (Y/N) Electron ic Data Source Used (Y/N) Reasonable Compatibility Standard Used Specify Reasonable Compatibility Standard for Income Ask for a Reasonabl e Explanatio n from the Individual (Y/N) Paper Documentati on Required from the Individual (Y/N) Comments Age (Date of Birth) NO NO YES N/A N/A NO YES Will use SSA data where available. If no SSA match, will accept attested age with post eligibility verification. If conflicting electronic information exists that would have an effect on eligibility, require paper. Social Security Number ** NO NO YES N/A N/A N/A YES Note: in addition to documents from applicant, protocols for resolving SSN conflicts involve research by a technical unit (see Additional Comments). Citizenship ** NO NO YES N/A N/A N/A YES Only require paper if electronic information absent or inconsistent with attestation. Immigration Status ** NO NO YES N/A N/A N/A YES Only require paper if electronic information absent or inconsistent with attestation. Household Composition YES NO NO N/A N/A NO NO We are not actively using particular sources to verify household composition. When conflicting data found that would have an effect on eligibility via PARIS or SNAP/TANF data, may require documentation from participant showing relationship to child, and parent's (or Court's) authorization for acting as caretaker. Pregnancy *** YES NO NO N/A N/A NO NO Caretaker Relative YES NO NO N/A N/A NO NO Not actively verifying caretaker relative status. However, if conflicting information is found from internal data sources that would have an effect on eligibility, will reach out to individual for an explanation or documentation from participant showing relationship to child, and parent's (or Court's) authorization for acting as caretaker. Medicare NO YES YES N/A NO NO State will use SVES/SOLQ/SDX to verify. Presence or absence of Medicare is not a criterion for Medicaid eligibility, but the existence of Medicare eligibility requires an individual to be redirected away from the MAGI process. If an applicant feels s/he has been referred to non-MAGI in error due to disputed Medicare eligibility, s/he may use the (Exchange) Call Center, a navigator, a case worker, or other assisters to engage in further discussion/investigation. Application for Other Benefits NO YES YES N/A N/A YES YES Paper documentation collected ONLY if not available from hub or SVES/SOLQ/SDX and individual does not supply a reasonable explanation. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 2