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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: New Jersey 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 Income* NO NO YES Both are above, at or below the applicable income standard. 25% YES YES If individual attests to income below the applicable standard, and data source indicates income ab ove the applicable standard, and the difference betwee n the two is greater than 25%, then a reasonable explanation/ paper documentation will be required. If an individual attests to income ab ove the applicable standard and data source indicates income be low the standard, and the difference is more than 25%, the sta te will ask for additional information. If the individual is the n deemed ineligible, state will screen for APTC (Advance Premi um Tax Credits). Percent Threshold Residency YES NO NO N/A N/A NO NO Age (Date of Birth) YES NO NO N/A N/A NO NO Social Security Number ** NO NO YES N/A N/A N/A YES Citizenship ** NO NO YES N/A N/A N/A YES MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 2