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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: North Dakota Section C . Additional Factors of Eligibility for Separate CHIP Eligibility Factor Self- Attestation Accepted without Additional Verification Self- Attestation Accepted with Post- Enrollment Verification Electronic Data Source Used (Y/N) If Yes, please describe in comments Paper Documentati on Required from the Individual (Y/N) Non- Applicab le (N/A) Comments 1. Applicant does not have other coverage YES NO NO NO Must be Applied These verification procedures apply to Separate CHIP only. State's CHIP carrier, Blue Cross/Blue Shield, may identify inconsistencies in the attested data through data matching. Will request paper documentation when an individual is reporting that policy coverage has ended. For the title XXI Medicaid Expansion population, self-attestation will be accepted with post- enrollment verification. If a discrepancy is identified, paper documentation will be requested. 2. Applicant does not have access to affordable ESI YES NO NO NO If discrepancies are identified, further review will be required and paper documentation may be requested. 3. When child has had coverage (as applicable to states' waiting period) YES NO NO NO If discrepancies are identified, further review will be required and paper documentation may be requested. 4. Access to public employee coverage YES NO NO NO Paper documentation is requested to verify coverage only if individual indicates that they have insurance but not requested if the individual attests to not having insurance. 5a. Waiting period exception #1 (describe): NO YES YES YES Due to involuntary loss of employment 5b. Waiting period exception #2 (describe): NO YES YES YES Through no fault of any member of the Healthy Steps unit MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 9