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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Montana Section A. Verification Procedures for Factors of Eligibility Eligibility Factor Self- Attestation Accepted without Additional Verification (Y/N) Self- Attestatio n Accepted with Post- Eligibility Verificatio n (Y/N) Electron ic Data Source Used (Y/N) Reasonable Compatibility Standard Used Specify Reasonable Compatibili ty Standard for Income Ask for a Reasonabl e Explanatio n from the Individual (Y/N) Paper Documentati on Required from the Individual (Y/N) Comments Income* NO YES YES Both are above, at or below the applicable income standard. Percent Threshold 10% YES YES The initial eligibility determination will be based solely on self-attestation. Within six months of application, electronic data sources will be accessed. If the individual attests to income below the applicable standard, and the data source indicates income above the applicable standard, and the difference between the two is less than 10% then the state will consider that reasonably compatible and the individual is enrolled. If the individual attests to income below the applicable standard, and the data source indicates income above the applicable standard, and the difference between the two is greater than 10% , the State will request a reasonable explanation, or paper documentation from the individual to resolve the discrepancy. When an individual attests to income above the applicable standard and data source indicates income below the standard, the state will take the attestation and make the person ineligible and screen for APTC (Advance Premium Tax Credits). Residency YES NO NO N/A N/A NO NO Age (Date of Birth) NO NO YES N/A N/A YES YES If data source indicates an inconsistency that would affect eligibility we would ask for a reasonable explanation or documentation if necessary. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1