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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Nevada Section C . Additional Factors of Eligibility for Separate CHIP Eligibility Factor Self- Attestation Accepted without Additional Verification Self- Attestation Accepted with Post- Enrollment Verification Electronic Data Source Used (Y/N) If Yes, please describe in comments Paper Documentatio n Required from the Individual (Y/N) Non- Applicabl e (N/A) Comments 1. Applicant does not have other coverage NO YES YES YES Must be Applied Post enrollment verification by TPL vendor. Paper documentation required only if discrepancy This process also applies to Medicaid Expansion under Title XXI. 2. Applicant does not have access to affordable ESI N/A 3. When child has had coverage (as applicable to states' waiting period) NO YES YES YES Paper documentation required only if discrepancy While State is using a TPL vendor for data matching for all applicants, this is not used for eligibility purposes. However, if a discrepancy is found (i.e. coverage from another carrier is found while enrolled in CHIP) with existing records, paper documentation may be requested. If individual has coverage from another carrier while receiving CHIP benefits, an overpayment can be calculated and resolved with the individual. Quarterly matches are performed post-enrollment to identify if child has other coverage, that could affect enrollment. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 9