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Demonstration Approval Period: October 1, 2024 through September 30, 2029 Page 25 of 43

MEG PC or Agg WOW Only, WW Only, or Both Trend Rate DY 21 DY 22 DY 23 DY 24 DY 25 Demonstration Population 1 PC Both 4.84%

$1,923. 69

$2,016. 72

$2,114. 25

$2,216. 50

$2,323. 69

Composite Federal Share. The Composite Federal Share is the ratio that will be used to convert the total computable budget neutrality limit to federal share. The Composite Federal Share is the ratio calculated by dividing the sum total of FFP received by the state on actual demonstration expenditures during the approval period by total computable demonstration expenditures for the same period, as reported through MBES/CBES and summarized on Schedule C. Since the actual final Composite Federal Share will not be known until the end of the demonstration’s approval period, for the purpose of interim monitoring of budget neutrality, a reasonable estimate of Composite Federal Share may be developed and used through the same process or through an alternative mutually agreed to method. Each Budget Neutrality Test has its own Composite Federal Share, as defined in the paragraph pertaining to each particular test. Corrective Action Plan. If at any time during the demonstration approval period CMS determines that the demonstration is on course to exceed its budget neutrality expenditure limit, CMS will require the state to submit a corrective action plan for CMS review and approval. CMS will use the threshold levels in the tables below as a guide for determining when corrective action is required. Table 5: Budget Neutrality Test Corrective Action Plan Calculation Demonstration Year Cumulative Target Definition Percentage DY 21 Cumulative budget neutrality limit plus: 2.0 percent DY 21 through DY 22 Cumulative budget neutrality limit plus: 1.5 percent DY 21 through DY 23 Cumulative budget neutrality limit plus: 1.0 percent DY 21 through DY 24 Cumulative budget neutrality limit plus: 0.5 percent