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MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 10

MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Mississippi Last updated 01/04 2021

Section C . Additional Factors of Eligibility for Separate CHIP Eligibility Factor Self- Attestat ion Accepte d without Additio nal Self- Attestatio n Accepted with Post- Enrollmen t Verificatio Electroni c Data Source Used (Y/N) If Yes, please describe Paper Document ation Required from the Individual (Y/N)

Non- Applicable (N/A) Comments Verificat ion n (Y/N) in commen ts 5g. Waiting period exception #7 (describe): N/A 5h. Waiting period exception #8 (describe): N/A 5i. Waiting period exception #9 (describe): N/A 5j. Waiting period exception #10 (describe): N/A 6. Other eligibility factors or exceptions to eligibility factors: (Please describe in the space provided below)