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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 Other: (Please describe any other eligibility factors in the space below) Public institution status NO YES YES N/A N/A YES NO Verified via Jail Match (from Dept. of Corrections) linked to MMIS. Incarceration status is used for limiting payment of benefits but does not preclude Medicaid eligibility. American Indian/Alaska Native YES NO NO N/A N/A NO NO Pursuant to 42 CFR § 435.603(e)(3), Maryland must exclude certain types of income for AI/AN populations from the calculation of modified adjusted gross income (MAGI) - having an individual self-identify as AI/AN will ensure that the income review process can flag these types of income to ensure they are not inappropriately counted. In addition, pursuant to 42 CFR 457.535, Maryland may not impose premiums (applicable to some CHIP) on AI/AN individuals. * 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