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MAGI-BASED ELIGIBILITY VERIFICATION PLANSECTION A - Verification Procedures for Factors of Eligibility 3 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 Pregnancy *** YES YES NO N/A N/A NO NO The State accepts self-attestation of pregnancy status for the purpose of an eligibility determination, per regulation. If claims data from internal MMIS indicates that the woman is not receiving prenatal care, the state will follow-up with the enrollee. Caretaker Relative YES NO NO N/A N/A NO NO Medicare NO NO YES N/A N/A NO NO The State verifies Medicare eligibility using BENDEX data and other SSA data sources. If inconsistency is identified, SSA will be contacted manually. Historically, the state has never had to reach out to individuals to verify information. Application for Other Benefits YES NO NO N/A NO NO Other: (Please describe any other eligibility factors in the space below) Incarceration NO YES YES N/A N/A NO YES * 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.