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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Missouri 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 YES NO NO NO Must be Applied Self- attestation is accepted as a rule. However, if information deemed discrepant by the state is received indicating other coverage and eligibility is affected, after reviewing available resources, the state may seek a reasonable explanation from the participant. The state may require paper documentation as a last resort prior to taking any adverse action. 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 NO NO NO N/A 4. Access to public employee coverage YES NO NO NO 5a. Waiting period exception #1 (describe): NO NO NO NO MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 10