MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: North Carolina Last updated 05/26/2016 Section A. Verification Procedures for Factors of Eligibility 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 Both are above, at or below the applicable income standard. N/A YES YES If the individual’s attestation is equal to or less than the applicable income standard and the automated verification source’s income is equal to or less than the income standard, the attestation is deemed reasonably compatible and the individual is income eligible. Subsequent automated income matches will be compared to the attestation for review. If the attestation is greater than the income standard and the automated verification source’s income is greater than the income standard, the applicant/beneficiary is income ineligible. If the attestation is less than the income standard and the automated verification source’s income is greater than the income standard, reasonable explanation and/or paper documentation will be requested. If the attestation is more than the income standard limit and the automated verification source’s income is less than the income standard limit, reasonable explanation and/or paper documentation will be requested. NC does not accept a percentage or dollar inconsistency, the state will ask for a reasonable explanation and/or paper documentation for all inconsistencies. Income* NO NO YES Other (Specify in Comments) Residency NO NO YES N/A N/A NO YES Paper would be required if no electronic data source verifies information per state law N.C.G.S. 108A-55.3 and affects eligibility. Age (Date of Birth) YES NO NO N/A N/A NO NO Self-attestion will be accepted, unless an inconsistency is identified in the course of verifying other information. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1