Page 1

MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Ohio 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. Other (Specify in Comments) 5% NO YES All income will be verified before enrollment. Where possible, electronic data sources will be used for real-time matches at time of application. If individual attests to income above the income standard and data source shows below, we will take their attestation and screen for APTC/CSR eligibility. If individual's attestation and electronic verification are both below the applicable standard, the attestation is accepted. If individual attests to income below the applicable standard and the data source shows income above the applicable income standard, income will be considered reasonably compatible if the difference between the attested income and electronic data verifications are within an amount less than or equal to 5% of 100% FPL for a family of one. If the difference in income exceeds this threshold, manual verification will be requested and the actual (verified) income will be used in the eligibility determination. If verification is not provided after a second request, the application would be denied for failure to cooperate by providing verifications. SSA, child support, worker compensation, and unemployment compensation data matches are used at time of application. Residency YES NO NO N/A N/A NO NO The state accepts self-attestation without additional verification. If the state receives conflicting information they will follow-up with verification, including paper if necessary. Age (Date of Birth) YES NO NO N/A N/A NO NO Self-attestation will be accepted unless available data conflicts with the attestation, and affects eligibility, which would require follow-up and paper documentation if necessary. Social Security Number ** NO NO YES N/A N/A N/A YES Citizenship ** NO NO YES N/A N/A N/A YES Immigration Status ** NO NO YES N/A N/A N/A YES MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1