Page 9

MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 9 Electronic Data Source To Be Used (Y/N) Social Security Number Citizenship Immigration Status Residency Age/DOB Pregnancy Household Composition Caretaker Relative Medicare Application for other Benefits Other Data Source Used at Application (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollment (Y/N) If Used for Post- Enrollment Frequency Used (i.e. monthly, quarterly) Comments 11. Commercial database: (Please describe any commercial databases in the space below) 12. PARIS* YES NO NO NO NO NO NO NO NO NO YES NO NO YES YES Quarterly PARIS data match is received quarterly, is used as a lead only. If PARIS is available and current at renewal it will be utilized. 13. Other: (Please describe additional electronic data sources in the space provided below) CMS: Medicare Part D interface YES YES NO NO NO YES NO NO NO YES NO NO YES NO NO An alert is received whenever there is a change. The frequency depends case by case and how many changes occur. This source can be used for SSN, residency, and DOB if needed to resolve inconsistencies. Would also assist with exempting an individual from the citizenship verification requirement if the person has Medicare. Nebraska receives Medicare Part A and B information from this interface. Will only be used for SSN if the SSN has been verified with SSA. * Under 42 CFR 435.945(d), all State Medicaid eligibility systems must conduct a match with PARIS for Interstate benefit information. If used for other purposes, please indicate in Section D.