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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) Health Management Systems (HMS) YES NO NO NO NO NO NO NO NO YES NO YES NO NO YES Monthly Vendor checks all TPL 13. Other: (Please describe additional electronic data sources in the space provided below) 12. PARIS* YES YES NO NO NO NO NO NO NO NO NO YES NO NO YES Quarterly State is only using this data source for SSN if we know that the SSN has been verified with SSA. Used to identify if an indiviudal is enrolled in benefits in another state. May identify if a person has moved out of state leading to an inconsistency with residency that needs to be folllowed up on. * 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 10