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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: North Dakota 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) Electroni c 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 NO YES Both are above, at or below the applicable income standard. Other (Specify in Comments) N/A (see comment) YES YES If individual attests to income below the applicable standard but the the data sources indicate income above the applicable standard, consider not reasonably compatible and ask for a reasonable explanation and or paper documentation. When an individual attests to income above the applicable standard but data sources indicate income below, the client would not be ineligible at that point. An eligibility worker would follow up with them to get information to make the final decision of eligibility. Residency YES NO NO N/A N/A NO NO Accept Self-attestation but if other data within the agency shows an inconsistency that could affect eligibility, state will request reasonable explanation/paper documentation. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1