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MAGI-BASED ELIGIBILITY VERIFICATION PLAN (Insert Medicaid, CHIP, or Both) Medicaid & CHIP State: VT Last updated: 2/28/2024

Section C. Additional Factors of Eligibility for Separate CHIP Eligibility Factor Self-Attestation Accepted without Additional Verification (Y/N) Self-Attestation Accepted with Post-Enrollment Verification (Y/N) Electronic Data Source Used (Y/N) Paper Documentation Required from the Individual (Y/N) Non-Applicable (N/A) Comments 1. Applicant does not have other coverage Yes No No No Must be Applied CHIP follows Medicaid rules and procedures. If an inconsistency is identified through other means, paper documentation may be required. 2. Applicant does not have access to affordable ESI

N/A

3. When child has had coverage (as applicable to states’ waiting period)

N/A

4. Access to public employee coverage

N/A

5a. Waiting period exception #1

N/A

5b. Waiting period exception #2

N/A

5c. Waiting period exception #3

N/A

5d. Waiting period for exception #4

N/A

5e. Waiting period for exception #5

N/A

5f. Waiting period for exception #6

N/A