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 Age (Date of Birth) NO YES YES N/A N/A YES YES Reasonable explanation/paper documentation requested when there is an inconsistency between the attestation and information from the data source that affects eligibility. If SSA cannot confirm the SSN, which means they cant verify citizenship, the reasonable opportunity period will be triggered to verify citizenship. What is provided to prove citizenship will serve the purpose of verifying age/DOB as well. Social Security Number ** NO NO YES N/A N/A N/A YES If an SSN is not verifiable via an electronic data source, paper documentation will be required. For example, if an individual does not have a number for religious reasons, the individual will have to provide documented proof of their good cause. Citizenship ** NO NO YES N/A N/A N/A YES Immigration Status ** NO NO YES N/A N/A N/A YES Household Composition YES NO NO N/A N/A NO NO Pregnancy *** YES NO NO N/A N/A NO NO Caretaker Relative YES NO NO N/A N/A NO NO Medicare NO YES YES N/A N/A NO NO When an inconsistency is identified between the attested information and the data source, state will use the data from SSA and auto populate the Medicare fields. Application for Other Benefits YES NO NO N/A N/A NO NO Other: (Please describe any other eligibility factors in the space below) * States must check electronic data sources determined useful to verify income in accordance with 42 CFR 435.948 but can be done post-enrollment. If the information obtained from electronic data sources and the information provided by or on behalf of the individual are both above, at or below the applicable income standard, the State must determine the applicant eligible or ineligible for Medicaid/CHIP. (NOTE: this option is prepopulated for the state and is not an option that can be changed). MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 2

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 ** States must follow statute, regulations, and guidance for verification of SSN, citizenship and immigration status including obtaining such information through the federal data services hub if available. *** States must accept self-attestation of pregnancy unless they have information that is not reasonably compatible with such attestation. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 3

MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: New Hampshire

Date Submitted: (mm/dd/yyyy) 08/19/2025 Section B1. Use of Electronic Data Sources Financial: Electronic Data Source Determined Useful (Y/N)1 Accuracy Considered (Y/N) Timeliness Considered (Y/N) Ability to Access Considered (Y/N) Age of Data Considered (Y/N) Comprehensive Considered (Y/N) Other Criteria Used (Y/N) (Please Describe in Comments section) Data Source Used at Application (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollment (Y/N) If Data Source Used for Post- Enrollment - Frequency Used (e.g. monthly, quarterly) Comments 1. Internal Revenue Service (IRS) NO NO NO NO NO NO NO NO NO NO The issue with this data source is that the data is old and does not necessarily reflect the individual's current financial circumstances. NH has more current sources of electronic verification of both wages and unearned income. 2. Social Security Administration (SSA) (SSI, Title II) YES YES YES YES YES YES NO YES YES YES Monthly We will use the electronic verification through the HUB and our current Data Exchange Post-Eligibility. For further clarification see details in Section A. 3. State Wage Information Collection Agency (SWICA) YES YES YES YES YES YES NO NO YES YES Other (specify in comments) The information provided in this data source is more current that IRS data. For further clarification see details in Section A. 4. State Unemployment Compensation YES YES YES NO YES YES NO NO YES YES Other (specify in comments) For further clarification see details in Section A. 5. State Administered Supplementary Payment Program YES YES YES YES YES YES NO NO YES YES Other (specify in comments) This would only ever be used if the client's attested income is outside of the 10% income threshold and the program has more current information. *An Implementation Date of 5/31/2025 for reasonable compatibility standard of 10% 6. State General Assistance Programs NO NO NO NO NO NO NO NO NO NO NH does not have a State General Assistance program. 7. Supplemental Nutrition Assistance Program (SNAP) YES YES YES YES YES YES YES NO YES YES Other (specify in comments) This would only ever be used if the client's attested income is outside of the 10% income threshold and the program has more current information. Only used for the raw income data. *An Implementation Date of 5/31/2025 for reasonable compatibility standard of 10% MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B1 - Use of Electronic Data Sources, Financial 4

Electronic Data Source Determined Useful (Y/N)1 Accuracy Considered (Y/N) Timeliness Considered (Y/N) Ability to Access Considered (Y/N) Age of Data Considered (Y/N) Comprehensive Considered (Y/N) Other Criteria Used (Y/N) (Please Describe in Comments section) Data Source Used at Application (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollment (Y/N) If Data Source Used for Post- Enrollment - Frequency Used (e.g. monthly, quarterly) Comments 8. Temporary Assistance for Needy Families (TANF) YES YES YES YES YES YES YES NO YES YES Other (specify in comments) This would only ever be used if the client's attested income is outside of the 10% income threshold and the program has more current information. Only used for the raw income data. *An Implementation Date of 5/31/2025 for reasonable compatibility standard of 10% 9. Office of Child Support Enforcement (OCSE) NO NO NO NO NO NO NO NO NO NO NECSES does not provide alimony information. 10. State Income Tax NO NO NO NO NO NO NO NO NO NO NH does not have a State Income Tax. 11. Commercial database: (Pease describe any commercial databases in the space below) Verify Direct (free version) YES YES YES YES YES YES YES NO YES YES Other (specify in comments) One large NH employer uses this company. There is a 3 - 5 day turn-around from date of request to receipt of data. The information is accurate. NH uses the free version. This Data Source will be used to verify individual income for post- enrollment and renewal on an "as necessary" basis. For further clarification see details in Section A. 12. Other: (Please describe any additional electronic data sources in the space below) PARIS YES YES NO NO NO NO NO NO NO YES Quarterly The PARIS income data is generally not current, so is of limited use. 1. The state marked any criterion YES if it was considered as a reason the data source was determined useful/not useful. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B1 - Use of Electronic Data Sources, Financial 5

MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: New Hampshire Date Submitted: (mm/dd/yyyy) 08/19/2025 Section B2. Use of Electronic Data Sources Non-Financial: 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 1. Social Security Administration (SSA) YES YES YES NO NO YES NO NO NO YES NO NO YES NO YES Other (specify in comments) Used at application for SSN, Citizenship, and Age. Internal SSA feed used post-enrollment for Medicare. 2. Department of Homeland Security (DHS) - SAVE YES NO NO YES NO NO NO NO NO NO NO NO YES NO NO Used for non-citizenship. 3. Vital Statistics Other To verify date of birth/citizenship only as (specify in necessary to verify conflicting data with SSA. YES NO YES NO NO YES NO NO NO NO NO NO YES NO YES comments) Age/DOB verified Post Enrollment. 4. Department of Motor Vehicles (DMV) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NH DHHS currently does not have an agreement with the Department of Motor Vehicles to provide such information. 5. Temporary Other Information will be used as available. NH Assistance for (specify in has a consolidated eligibility system. Only Needy Families comments) use for SSN if verified with SSA first. Only (TANF) YES YES YES YES NO YES NO NO NO NO NO NO YES YES YES use for citizenship and immigration status if verified in accordance with Medicaid/CHIP rules. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 6

necessary, PARIS can be used to verify residency. 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 6. Supplemental Nutrition Assistance Program (SNAP) YES YES YES YES NO YES NO NO NO NO NO NO YES YES YES Other (specify in comments) Information will be used as available. NH has a consolidated eligibility system. Only use for SSN if verified with SSA first. Only use for citizenship and immigration status if verified in accordance with Medicaid/CHIP rules. 7. Office of Child Support Enforcement NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 8. State General Assistance Programs NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Not Applicable 9. Women, Infants and Children Program (WIC) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Not Applicable 10. State Income Tax NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Not Applicable 11. Commercial database: (Please describe any commercial databases in the space below) 12. PARIS* YES NO NO NO NO NO NO NO NO NO NO YES NO NO YES Quarterly VA match and interstate benefits analysis. The PARIS information is generally not current, so is of limited use. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 7

Electronic Data Source

To Be

Used (Y/N) Social Security mber Nu ip Citizensh Immigration Status Residency B Age/DO Pregnancy Household Composition Caretaker Relative Medicare ion Applicat her for ot 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

13. Other: (Please describe additional electronic data sources in the space provided below)

* 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. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 8

MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: New Hampshire Date Submitted: (mm/dd/yyyy) 08/19/2025 Section C . Additional Factors of Eligibility for Separate CHIP Eligibility Factor Self-Attestation Accepted without Additional Verification Self-Attestation Accepted with Post-Enrollment Verification (Y/N) Electronic Data Source Used (Y/N) If Yes, please describe in comments Paper Documentation Required from the Individual (Y/N) Non- Applicable (N/A) Comments 1. Applicant does not have other coverage YES NO NO NO Must be Applied NH has a title XXI Medicaid Expansion component.The same verification procedures apply as applied to title XIX Medicaid. 2. Applicant does not have access to affordable ESI YES NO NO NO 3. When child has had coverage (as applicable to states' waiting period) N/A NH does not have a waiting period for its CHIP expanded Medicaid coverage. 4. Access to public employee coverage YES NO NO NO 5a. Waiting period exception #1 (describe): N/A 5b. Waiting period exception #2 (describe): N/A 5c. Waiting period exception #3 (describe): N/A 5d. Waiting period exception #4 (describe): N/A 5e. Waiting period exception #5 (describe): N/A 5f. Waiting period exception #6 (describe): N/A 5g. Waiting period exception #7 (describe): N/A 5h. Waiting period exception #8 (describe): N/A 5i. Waiting period exception #9 (describe): N/A 5j. Waiting period exception #10 (describe): N/A MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 9

Eligibility Factor Self-Attestation Accepted without Additional Verification Self-Attestation Accepted with Post-Enrollment Verification (Y/N) Electronic Data Source Used (Y/N) If Yes, please describe in comments Paper Documentation Required from the Individual (Y/N) Non- Applicable (N/A) Comments 6. Other eligibility factors or exceptions to eligibility factors: (Please describe in the space provided below) MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 10

MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: New Hampshire Date Submitted: (mm/dd/yyyy) 08/19/2025 Section D. Additional Verification Questions Question Response 1 If paper documentation is required when a data source is not available or the information obtained from a data source is not reasonably compatible with the information provided by or on behalf of the individual, briefly describe how the state determined that establishing and using an electronic data source was not effective, considering such factors as cost and program integrity in accordance with 42 CFR 435.952(c): The state accepts self-attestation without additional verification for many factors of eligibility. For those it doesn't, the state used all available data sources. including vital statistics as a back-up for citizenship verification, and asks for a reasonable explantion from the individual or another person who can verify information for an explanation if the attestation and information from the data source are inconsistent before asking for paper documenation. 2 Please describe how the state uses PARIS? New Hampshire uses 3 PARIS data matches: (1) The Veterans Administration (VA) - matches with the VA to determine if a client is collecting VA benefits. This match is currently being utilized as a third party liability (TPL) tool to "cost avoid" and to verify VA benefits. (2) The Federal match - determines whether anyone receiving public assistance benefits is also collecting a payment as a U.S. Federal or military employee in the form of retirement pension or as a current member of the military or civilian workforce. This match is currently being utilized as a TPL tool to "cost avoid" Medicaid claims; and (3) The Interstate match which matches against other States public assistance information to determine if a client is collecting benefits (Medicaid, TANF & SNAP) in more then one state. In some cases, this has been helpful with residency post-eligibility: 3 Please indicate (YES) or (NO) if the State intends to request Secretarial approval to solely use alternative data sources for financial verification other than those listed in 42 CFR 435.948 (Numbers 1-8 in Section B-1). NO MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION D - Additional Verification Questions 11

Question Response If (YES), please submit a letter to CMS requesting such approval describing how the state meets the following requirements: 1) Reduces administrative costs and burdens on both individuals and the State, 2) Maximizes accuracy and minimizes delay, 3) Meets the requirements related to confidentiality, disclosure, maintenance and use of information, and 4) Promotes coordination with other insurance affordability programs. 4 Please indicate (YES) or (NO) if the State intends to request Secretarial approval to use a mechanism other than the federal data services hub for information that is available through the hub. NO If (YES), please submit a letter to CMS requesting such approval describing how the state meets the following requirements: 1) Reduces administrative costs and burdens on both individuals and the State, 2) Maximizes accuracy and minimizes delay, 3) Meets the requirements related to confidentiality, disclosure, maintenance and use of information, and 4) Promotes coordination with other insurance affordability programs. 5 Describe any additional MAGI-based eligibility verification policies and procedures that have not been covered in this verification plan (optional): MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION D - Additional Verification Questions 12

Section A. Additional Comments MAGI-BASED ELIGIBILITY VERIFICATION PLAN Additional Comments 13

Section B1. Additional Comments MAGI-BASED ELIGIBILITY VERIFICATION PLAN Additional Comments 14

Section B2. Additional Comments MAGI-BASED ELIGIBILITY VERIFICATION PLAN Additional Comments 15

Section C. Additional Comments MAGI-BASED ELIGIBILITY VERIFICATION PLAN Additional Comments 16