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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: South Carolina 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 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 TPL Vendor is Blue Cross Blue Shield of South Carolina. Paper documentation requested if there is a discrepancy between the electronic source and the individual's report. 2. Applicant does not have access to affordable ESI 3. When child has had coverage (as applicable to states' waiting period) 4. Access to public employee coverage 5a. Waiting period exception #1 (describe): 5b. Waiting period exception #2 (describe): 5c. Waiting period exception #3 (describe): 5d. Waiting period exception #4 (describe): 5e. Waiting period exception #5 (describe): 5f. Waiting period exception #6 (describe): MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 12