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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: New Jersey 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 NO YES YES NO Must be Applied Commercial data source from HMS used. Paper documentation required only for when insurance has ended. This process also applies to Medicaid expansion program. Questions 2-6 are not applicable to this population. No waiting periods for these children. 2. Applicant does not have access to affordable ESI NO YES YES NO Will check with other database systems on the backend post-verification. Will enroll them and then perform TPL check on the backend. It's an electronic process via vendor HMS. Utilize HMS vendor for verification. 3. When child has had Commercial data source from HMS used. Termination letter from insurance company coverage (as applicable to required. states' waiting period) NO YES YES YES If a child applies for Medicaid expansion under CHIP, NJ will also verify that applicant does not have other coverage. Caveat: child has the option of keeping Medicaid expansion but dropping other insurance. Verification still on the back end. 4. Access to public employee coverage NO YES YES YES 5a. Waiting period exception #1 (describe): NO NO NO YES Up to 350%, lost through no fault of your own, drop private individual insurance or COBRA expires - paper documentation required before enrollment. 5b. Waiting period exception #2 (describe): NO NO NO YES Up to 200%, stop paying COBRA benefits - paper documentation required before enrollment. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 11