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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Rhode Island 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 YES Must be Applied use Rite Share database and calculator to determine cost-effectiveness of ESI to State; may require that applicant obtain documentation from employer about cost of ESI and benefit summary/coverage limits; same procedures apply to Medicaid expansion under Title XXI 2. Applicant does not have access to affordable ESI NO YES YES YES use Rite Share database and calculator to determine cost-effectiveness of ESI to State; may require that applicant obtain documentation from employer about cost of ESI and benefit summary/coverage limits; same procedures apply to Medicaid expansion under Title XXI 3. When child has had coverage (as applicable to states' waiting period) N/A 4. Access to public employee coverage N/A 5a. Waiting period exception #1 (describe): N/A 5b. Waiting period exception #2 (describe): N/A MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibilty for Separate CHIP 8