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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 Caretaker Relative YES NO YES N/A N/A YES YES Wyoming will be receiving caretaker relative data through the Hub (IRS data). If the individual is unknown through the Hub (i.e. individual is not a tax filer), the State will accept self- attestation without additional verification. If this individual is known to the Hub (i.e. individual is a tax-filer) and there is a discrepancy between what is found in the Hub and what the individual attests to, then paper documentation may be requested for clarification although it is thought that a reasonable explanation may provide clarity. There is no other data source available besides the IRS to verify this information. Medicare NO NO YES N/A N/A NO YES Paper documentation will be requested if the information provided is not compatible with information from the data source. Application for Other Benefits NO YES YES N/A N/A NO YES Electronic data sources will be used to indentify individuals required to pursue other benefits. Paper documentation of an application for other benefits may be required if it cannot be confirmed through electronic data sources post-eligibility. Other: (Please describe any other eligibility factors in the space below) * 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 3