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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) State: last updated: Medicaid & CHIP Utah 04/08/2016 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 NO YES YES Must be Applied Customer statement is accepted. However, if our electronic interface from Office of Recovery Services (ORS) shows that the customer has an insurance, this discrepancy must be addressed. An email is sent to ORS to verify if the customer still has the insurance; if the customer does not have the insurance, the TPL is removed in our system. If the ORS verifies that the customer has insurance, but the customer still states that they do not, the customer can provide additional documentation to provide to ORS. 2. Applicant does not have access to affordable ESI NO NO NO YES Utah has a an Employer's Health Insurance Information Form that we require customer's employer or human resource personnel to complete to verify if the customer has available health insurance. At application and review we verify before we approve the case. 3. When child has had coverage (as applicable to states' waiting period) NO NO YES YES If the customer has had the information known to ORS, we send an email to ORS to verify the termination of the insurance. If the customer is not known to ORS, a certificate of coverage or other documentation to show the termination of the insurance is requested from the customer. 4. Access to public employee coverage NO YES YES YES We gather this information at application through self-attestation. If the electronic data source shows a discrepancy with client attestation then we request additional information from the customer. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 14