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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