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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 Household Composition YES NO NO N/A N/A NO NO Source: Household composition in Maine's eligibility system. For most cases Maine will accept self-attestion without additional verification unless the state is made aware that there is a discrepancy. In such cases, will ask for an explanation and paper documentation only if necessary. Pregnancy *** YES NO NO N/A N/A NO NO Source: pregnancy information in Maine's eligibility system and other program records (e.g. SNAP, TANF, etc.) For most cases Maine will accept self-attestation without additional verification unless the state is made aware of a discrepancy. In such cases, will ask for an explanation and paper documentation only if necessary. Caretaker Relative YES NO NO N/A N/A NO NO Source: caretaker relative information in Maine's eligibility system and other program records (e.g. SNAP, TANF, etc). For most cases Maine will accept self-attestion without additional verification unless the state is made aware of a discrepancy. In such cases, will ask for an explanation and paper documentation only if necessary. Medicare NO YES YES N/A N/A YES YES Source: SSA BENDEX. Maine requests a copy of the individual's Medicare card when there is a discrepancy with the SSA match. Application for Other Benefits NO YES YES N/A N/A YES YES Sources: information in Maine's eligibility system and PARIS. Maine may follow up post eligibility in situations where the individual is awaiting a decision on other benefits such as VA. Paper documentation may be required if we cannot verifiy electronically. Other: (Please describe any other eligibility factors in the space below) MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 4