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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 Caretaker Relative YES NO YES N/A N/A YES YES Accept self-attestation unless information within the integrated system (SNAP and TANF) conflicts with application. Reasonable explanation is then requested. Accept self-attestation unless individual is in the SNAP/TANF files and information within the integrated system (SNAP and TANF) conflicts with application. Reasonable explanation is then requested. For example, if a discrepancy such as a P.O. Box or hospital address is found, then they will use an EDS to investigate further. Electronic data sources may include SNAP and/or TANF If the information that comes back is still questionable, then they will ask for a reasonable explanation or paper documentation. For all other individuals, self-attestation is accepted. Medicare NO YES YES N/A N/A YES YES Would seek additional information if needed on a case by case basis. South Dakota will use SSA/CMS data source but will not use data sources from the HUB. Application for Other Benefits YES NO NO N/A N/A NO NO N/A Other: (Please describe any other eligibility factors in the space below) * States must check electronic data sources determined useful to verify income in accordance with 42 CFR 435.948 but can be done post-enrollment. If the information obtained from electronic data sources and the information provided by or on behalf of the individual are both above, at or below the applicable income standard, the State must determine the applicant eligible or ineligible for Medicaid/CHIP. (NOTE: this option is prepopulated for the state and is not an option that can be changed). ** States must follow statute, regulations, and guidance for verification of SSN, citizenship and immigration status including obtaining such information through the federal data services hub if available. *** States must accept self-attestation of pregnancy unless they have information that is not reasonably compatible with such attestation. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 5