MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: Utah last updated: 04/08/2016 Section A. Verification Procedures for Factors of Eligibility 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 Income* NO NO YES Both are above, at or below the applicable income standard. Both are above, at or below the applicable income standard. NO YES If the discrepancy does not effect enrollment, no action is taken. (Example both the attested amount and the verified levels are below or above the income standard). If eligibility is effected and if no electronic match or data is not reasonably compatible meaning that the individual attested to income below the applicable income limit and electronic data sources show income above, will request paper documentation. If the individual attested to income above the applicable income limit and electronic data sources show income below will request paper documentation. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 1