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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: South Dakota 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 South Dakota does not have electronic data sources available at time of application but will use data sources post-enrollment (e.g., HMS and South Dakota Division of Child Support). Follow-up if a discrepancy is found. If not resolved through follow-up, paper documentation will be required. These verification policies and procedures (for questions 1 and 2) also apply to the state Medicaid Expansion program according to title XXI. Questions 3-6 do not apply to the Medicaid Expansion program. No waiting periods would apply to the Medicaid expansion programs. 2. Applicant does not have access to affordable ESI N/A N/A - South Dakota does not use "access to" as an eligibility requirement. 3. When child has had Accept self-attestation but if the application or records from other human services program(s) coverage (as applicable to NO YES YES YES shows a conflict, the state will follow-up with the individual and ask for an explanation or states' waiting period) paper documentation. Data sources may include HMS and SSA Medicare for children with renal. 4. Access to public employee coverage YES NO NO NO 5a. Waiting period exception #1 (describe): NO YES NO YES Cost of the discontinued coverage for the child exceeded 5% of the household income 5b. Waiting period exception #2 (describe): NO YES NO YES Cost of family coverage that includes the child exceeds 9.5% of the household income 5c. Waiting period exception #3 (describe): YES NO NO NO The employer stopped offering coverage of dependents MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibilty for Separate CHIP 13