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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 Medicare NO NO YES N/A N/A YES YES The primary data source will be the Social Security service through the Federal Data Services Hub. As a back up if the Hub is down, for individuals already known to the integrated system, Medicare enrollment will be veriified through SNAP or TANF. In cases where Medicare data is not available or where there is a conflict between information in the file, the State may request additional information from the client. Paper documentation is only required from the client if they are unable to provide a satisfactory reasonable explanation for the compatibility issue. Application for Other Benefits YES NO NO N/A N/A NO NO State would accept self-attestation without additional verification from the individual. If inconsistencies are identified through the course of verifications for other programs or reported changes, State may reach out for further information. Other: (Please describe any other eligibility factors in the space below) Other Insurance Coverage NO YES YES N/A N/A YES YES This is specific for the CHIP population. State will reach out for paper documentation if a reasonable explanation is not sufficient or available. This verification occurs monthly. * 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 4