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MAGI-BASED ELIGIBILITY VERIFICATION PLAN Section A – Verification Procedures for Factors of Eligibility 3

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 Pregnancy *** YES NO NO N/A N/A NO NO Paper documentation is required if available information such as claims data conflicts with the individual's self-attestation regarding pregnancy. Caretaker Relative NO NO YES N/A N/A NO YES If relationship cannot be verified by an available electronic data source or if a discrepancy exists, paper documentation is required. Accept self-attestation of deprivation. Medicare NO NO YES N/A N/A NO YES Requiring paper documentation to resolve discrepancies in Medicare entitlement may be necessary in rare instances. Application for Other Benefits YES NO NO N/A N/A NO NO Other: (Please describe any other eligibility factors in the space below) IV-D Child Support Agency NO YES YES N/A N/A NO NO Failure to comply with IV-D requirements is handled post enrollment as notifications are received from the child support agency. Title II 40 Work Quarters NO NO YES N/A N/A NO NO Mississippi accepts self-attestation of receipt of means-tested federal benefits, other than Medicaid, when crediting qualifying quarters. Third Party Liability YES NO NO N/A N/A NO NO * 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.