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Demonstration Approval Period: October 1, 2024 through September 30, 2029 Page 9 of 43

for Medicaid, who are not inpatients in a long term care institution, and whose:

i. Income is at or below 135 percent of the FPL for an individual or couple, calculated using a methodology based on the Supplemental Security Income (SSI) program, as well as income exclusions approved under the state plan under the authority of section 1902(r)(2) of the Social Security Act; and,

ii. Resources are below $4,000 for an individual and $6,000 for a couple.

17. Enrollment Cap. The Healthier Mississippi enrollment cap is 6,000. When enrollment reaches 6,000, further enrollment is suspended and individuals making an application are placed on a waiting list. Individuals are moved off the waiting list and enrolled in the demonstration as openings become available.

18. Benefit Package. Children (ages 0 through 20) enrolled in the demonstration receive all Medicaid state plan benefits, including Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Adults (ages 21 and older) enrolled in the demonstration receive most services covered under the Medicaid state plan with the same service limits per the Medicaid state plan. Maternity and newborn care are available to individuals who need them by enrolling in Medicaid on a different basis.

Services Not Covered for Adults Swing bed in a skilled nursing facility Long-term care services (nursing facility, home and community-based waiver, and ICF/IID services) Maternity and Newborn Care

Admission to Nursing Facilities: Expenditures incurred for any services received while a Healthier Mississippi enrollee is an inpatient in a long-term care institutional setting will not be claimed under the demonstration. Any individual enrolled in Healthier Mississippi who is admitted to a nursing facility or other long term care setting, either temporarily (for less than 30 days) or for a longer admission, will be assessed for eligibility under a Medicaid State Plan covered category. Such individuals will be disenrolled from the demonstration upon admission to an institution and assessed for re- enrollment into the demonstration upon discharge from the institutional setting.

19. Cost Sharing. There are no cost-sharing requirements for children enrolled in the demonstration. Adult recipients are subject to cost sharing requirements that would be applicable if they were provided coverage under the state plan. A family’s total annual out- of-pocket cost sharing cannot exceed five percent of the family’s gross income. There is no premium charged for any recipient under the demonstration.