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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 5. Temporary Assistance for Needy Families (TANF) YES NO NO NO NO NO NO NO NO NO NO NO YES NO NO Other (specify in comments) Medicaid will use common system module for establishing unique identifiers and will process some individuals known to other programs. At application, Medicaid will use existing identifier for applicant known to TANF. Information available via TANF records can affect any of these factors. 6. Supplemental Nutrition Assistance Program (SNAP) YES NO NO NO NO NO NO NO NO NO NO NO YES NO NO Other (specify in comments) Medicaid will use common system module for establishing unique identifiers and will process some individuals known to other programs. At application, Medicaid will use existing identifier for applicant known to SNAP. Information available via SNAP records can affect any of these factors. 7. Office of Child Support Enforcement YES NO NO NO NO NO NO NO NO NO NO NO YES NO NO Other (specify in comments) Medicaid will use common system module for establishing unique identifiers and will process some individuals known to other programs. At application, Medicaid will use existing identifier for applicant known to OCSE. Information available via OSCE records can affect any of these factors. 8. State General Assistance Programs NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 9. Women, Infants and Children Program (WIC) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 10. State Income Tax NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 8