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Demonstration Approval Period: October 1, 2024 through September 30, 2029 Page 2 of 43

CENTERS FOR MEDICARE & MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS

NUMBER: 11-W-00185/4

TITLE:

Healthier Mississippi Demonstration

AWARDEE: Mississippi Division of Medicaid

I. PREFACE

The following are the Special Terms and Conditions (STCs) for the Healthier Mississippi section 1115(a) Medicaid demonstration extension (hereinafter “demonstration”). The parties to this agreement are the Mississippi Division of Medicaid (state) and the Centers for Medicare & Medicaid Services (CMS). The STCs set forth in detail the nature, character, and extent of federal involvement in the demonstration and the state’s obligations to CMS during the life of the demonstration. The STCs for the demonstration extension are effective as of October 1, 2024, through September 30, 2029, unless otherwise specified. All previously approved STCs are superseded by the STCs set forth below.

The STCs have been arranged into the following subject areas:

II. Program Description and Objectives III. General Program Requirements IV. Eligibility, Benefits, and Cost Sharing V. Delivery Systems VI. Monitoring and Reporting Requirements VII. General Financial Requirements VIII. Monitoring Budget Neutrality IX. Evaluation of the Demonstration X. Schedule of State Deliverables

Attachment A: Developing the Evaluation Design Attachment B: Preparing the Evaluation Report Attachment C: Evaluation Design (reserved)