us-mi/policy/cms/magi-verification-plan

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us-mi/policy/cms/magi-verification-plan — Axiom

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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 Caretaker Relative YES NO NO N/A N/A NO NO Medicare NO YES YES N/A N/A NO YES Post enrollment checks automatically validate enrolled population against TPL and MMA Application for Other Benefits YES NO NO N/A N/A NO NO Applicants must avail themselves of other potential benefits including Medicare and SSI. For the majority of cases, the State accepts self-attestation without additional verification. However if the state is made aware of inconsistencies though the course of other verifications or reported information, the State has systems in place that can perform verification. In such cases additional information including paper documentation maybe be requested if it were to affect eligibility.

Other: (Please describe any other eligibility factors in the space below) * 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 2

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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Michigan Section B1. Use of Electronic Data Sources Financial: Electronic Data Source Determined Useful (Y/N)1 Accuracy Considered (Y/N) Timeliness Considered (Y/N) Ability to Access Considered (Y/N) Age of Data Considered (Y/N) Comprehensive Considered (Y/N) Other Criteria Used (Y/N) (Please Describe in Comments section) Data Source Used at Application (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollment (Y/N) If Data Source Used for Post- Enrollment - Frequency Used (e.g. monthly, quarterly) Comments 1. Internal Revenue Service (IRS) YES YES YES YES YES YES NO YES YES NO Used at renewal to the extent consent is provided. 2. Social Security Administration (SSA) (SSI, Title II) YES YES YES YES YES YES NO YES YES YES Other (specify in comments) State intends to use Hub data at application and renewal. State will continue with bi-monthly post-enrollment data matches through the State-SSA connection. 3. State Wage Information Collection Agency (SWICA) NO YES YES YES YES YES NO NO NO YES Quarterly Based on the timeliness and comprehensiveness of the data it is not going to be used for the October release but will stay in scope as a possible TDS To clarify Michigan's approach to wage data: Michigan uses attested data for the MAGI calculation. The TDS data is used to validate the attested data. Wage data outside of reasonably compatible causes the application to pend for further verification by the applicant Due to a delay in having a new eligibility system fully operational, MI is only able to collect income information from IRS and SSA(Title II) through the Hub. We currently do not have the capability to retrieve TALX data through the Hub or access any state/local current data sources, including SWICA, for current income information. As a result, MI must ask for paper documentation if IRS or SSA data is outside of our 10% reasonable compatibility standard. We intend this to be a temporary process until the new system is fully functional, late in 2014. 4. State Unemployment Compensation NO YES YES YES YES YES NO NO NO YES Quarterly State Unemployment Compensation data is not going to be used for the October release for initial determination but will stay in scope as a possible TDS. Michigan does not have an automated interfaces with UI data at this time. Verification Plan to be updated if/when state does have automated interface. 5. State Administered Supplementary Payment Program NO NO NO NO NO NO NO NO NO NO The State will not use State Administered Supplementary Payment Program data. This data will not be available for release 1 (october 2013), and is not yet scheduled for a future release at this time. 6. State General Assistance Programs NO NO NO NO NO NO NO NO NO NO Non-existent for Michigan 7. Supplemental Nutrition Assistance Program (SNAP) NO YES YES YES YES YES NO NO NO NO Michigan will not use SNAP data for release 1 (October 2013) nor is use of SNAP data scheduled for a future release at this time. 8. Temporary Assistance for Needy Families (TANF) NO YES YES YES YES YES NO NO NO NO Michigan will not use TANF data for release 1 (October 2013) nor is use of TANF data scheduled for a future release at this time. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B1 - Use of Electronic Data Sources, Financial 3

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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 Application (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollment (Y/N) If Used for Post- Enrollment Frequency Used (i.e. monthly, quarterly) Comments 4. Department of Motor Vehicles (DMV) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Michigan is implementing a phased approach to incorporating trusted data sources. During the initial roll out only data sources available through the Federal Data Hub will be used. Subsequent data sources and validation rules will be added over time. This data source is being considered for use after the initial roll out to verify residency. 5. Temporary Assistance for Needy Families (TANF) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Michigan is implementing a phased approach to incorporating trusted data sources. During the initial roll out only data sources available through the Federal Data Hub will be used. Subsequent data sources and validation rules will be added over time. This data source is being considered for use after the initial roll out 6. Supplemental Nutrition Assistance Program (SNAP) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Michigan is implementing a phased approach to incorporating trusted data sources. During the initial roll out only data sources available through the Federal Data Hub will be used. Subsequent data sources and validation rules will be added over time. This data source is being considered for use after the initial roll out 7. Office of Child Support Enforcement NO NO NO NO NO NO NO NO NO NO NO NO NO NO YES Michigan is implementing a phased approach to incorporating trusted data sources. During the initial roll out only data sources available through the Federal Data Hub will be used. Subsequent data sources and validation rules will be added over time. This data source is being considered for use after the initial roll out 8. State General Assistance Programs NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO This currently does not exist in Michigan MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 6

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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Michigan Section C . Additional Factors of Eligibility for Separate CHIP Eligibility Factor Self-Attestation Accepted without Additional Verification Self-Attestation Accepted with Post- Enrollment Verification (Y/N) Electronic Data Source Used (Y/N) If Yes, please describe in comments Paper Documentation Required from the Individual (Y/N) Non- Applicable (N/A) Comments 1. Applicant does not have other coverage NO YES YES YES Must be Applied Monthly matches with Medicaid and Blue Cross after enrollment to check for other coverage Paper documentation is required if a discrepancy is found in the data match (i.e. If match shows the individual has active private insurance) For the Medicaid Expansion program, State accepts self-attestation without additional verification. If State finds out the applicant has other type of insurance, State would not bar the applicant from coverage. State would not bar the applicant for coverage for Medicaid coverage 2. Applicant does not have access to affordable ESI YES NO NO NO 3. When child has had coverage (as applicable to states' waiting period) NO YES YES YES Monthly matches with Medicaid and Blue Cross after enrollment to check for other coverage If a discrepancy is found through the electronic data match, state will request paper documentation from the applicant. 4. Access to public employee coverage YES NO NO NO 5a. Waiting period exception #1 (describe): YES NO NO NO Employer stopped allowing coverage of dependents 5b. Waiting period exception #2 (describe): YES NO NO NO Change of employment including involuntary separation resulting in loss of employee sponsored insurance 5c. Waiting period exception #3 (describe): YES NO NO NO Child loss coverage due to death or divorce of parent MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 8

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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Michigan Section D. Additional Verification Questions Question Response 1 If paper documentation is required when a data source is not available or the information obtained from a data source is not reasonably compatible with the information provided by or on behalf of the individual, briefly describe how the state determined that establishing and using an electronic data source was not effective, considering such factors as cost and program integrity in accordance with 42 CFR 435.952(c): The state plans to use Self Attestation for multiple eligibility factors. All other eligibility factors will be verified through electronic data sources available through the Hub prior to requesting reasonable explanation/paper documentation, if necessary. The State will only use paper verification in cases where no electronic data source exists through the hub and self-attestation is not reasonably compatible with data sources. Michigan is implementing functionality in iterative releases. The effort/duration and resource analysis the State did for release planning indicated that for the initial release, Michigan was able to incorporate trusted data sources through the Federal Data Hub. This approach was confirmed during the CMS Concept of Operations Meeting and the initial CMS Stage Gate meeting. Subsequent releases will include Michigan trusted data sources to supplement Federal Data Hub trusted data sources. 2 Please describe how the state uses PARIS? State of Michigan will use PARIS the same way as it is used today. It will be a post eligibility case maintenance function. The Beneficiary is instructed to contact the case worker to clarify discrepancies. 3 Please indicate (YES) or (NO) if the State intends to request Secretarial approval to solely use alternative data sources for financial verification other than those listed in 42 CFR 435.948 (Numbers 1-8 in Section B-1). NO MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION D - Additional Verification Questions 10

(michigan-medicaid-and-chip-verification-plan)Michigan MAGI-based eligibility verification plan (42 CFR 435.945(j)) as posted by CMS#

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(michigan-medicaid-and-chip-verification-plan)Michigan MAGI-based eligibility verification plan (42 CFR 435.945(j)) as posted by CMS#

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