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DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850

April 30, 2025

Rebecca de Camara State Medicaid Director Department of Public Health and Human Services 111 North Sanders, Room 301 Helena, MT 59601

Dear Director de Camara:

The Centers for Medicare & Medicaid Services (CMS) is approving an amendment to Montana’s section 1115(a) demonstration titled “Montana Plan First” (Project Number 11-W-00276/8) (the “demonstration”), in accordance with section 1115(a) of the Social Security Act (“the Act”). This amendment will be effective on the date of approval, through December 31, 2028, upon which date, unless extended or otherwise amended, all authorities granted to operate this demonstration will expire.

CMS determined that this demonstration categorized sexually transmitted infection (STI)/ sexually transmitted disease (STD) diagnosis services as a family planning service, which does not conform with State Medicaid Director Letters #10-0130F1, #14-0031F2, and #16-0082F3. In this guidance, CMS clarified that family planning related services are those services that are medical diagnosis services, including for STIs/STDs, that are provided pursuant to a family planning service. Family planning services must be for the purpose of preventing or delaying pregnancy. Therefore, in this amendment, CMS has identified STI/STD screening services as a family planning service and STI/STD diagnosis as a family planning related service.

Additionally, CMS updated attachments in the Special Terms and Conditions (STCs) to come into compliance with Executive Order 14168 ‘Defending Women’.

Budget Neutrality

There is no change to budget neutrality for this amendment.

Monitoring and Evaluation

There is no change to monitoring or evaluation requirement for this amendment.

1 https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD10013.pdf 2 https://www.medicaid.gov/federal-policy-guidance/downloads/smd-14-003.pdf 3 https://www.medicaid.gov/federal-policy-guidance/downloads/sho16008.pdf