Page 1

MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: New Hampshire Date Submitted: (mm/dd/yyyy) 08/19/2025 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. 10% YES YES If the individual attests to income below the applicable standard but the date source indicates income above the applicable standard, if the difference between the two is 10% or less, the state will consider the information reasonably compatible. If greater than 10% a reasonable explanation or paper documentation will be requested. In the instance of an individual attesting to income above the standard, but data source shows the income is below the standards, the individual will be ineligible for Medicaid and we would forward to the FFM for an APTC consideration. *An Implementation Date of 5/31/2025 for reasonable compatibility standard of 10% Further Details: NH accepts self-attestation in addition to receiving SSA data at application through the Hub. Any self-attested data is run through a post-enrollment nightly batch against pre-determined data sources (i.e. SWICA/UCB) the night the case is confirmed open for Medicaid. Once the data sources return the requested information (usually within 5-7 days), NH will automatically do the comparision described above. If we do not receive a response from the data sources within 30 days, NH will send a letter to the client requesting a reasonable explanation or paper documentation. Income* NO YES YES Percent Threshold Residency YES NO NO N/A N/A NO NO MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1