MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Rhode Island 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. Percent Threshold 10% YES YES If the individual attests to income below the applicable standard, and data source indicates income above the applicable income standard, if the difference between the two is 10% or less, the state will consider that reasonably compatible. If the difference is greater than 10%, reasonable explanation and/or paper documentation will be requested. If the individual attests to income above the applicable standard but data sources indicate income below, the state will determine them ineligible and screen for APTC. Rhode Island will match with local data sources first, then IRS if necessary. If not reasonably compatible and individual explains a recent job loss, State would then look at unemployment data for unemployment match before requesting paper documentation. Residency YES NO NO N/A N/A NO NO Age (Date of Birth) NO YES YES N/A N/A NO YES Will accept attestation but will verify through SSA or DHS to ensure correct DOB for purposes of paying correct capitation rate to managed care plan (rate varies by age and gender); second tier source will be RI Department of Health data if necessary and when link to data source is available; third source will be EVVE once data match agreement is in place; will also accept birth certificate or other legal document with DOB if necessary; will use this for applying correct capitation rates but eligibility will not be denied if DOB is incorrect. Social Security Number ** NO NO YES N/A N/A N/A YES MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1