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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

March 29, 2019

Marie Matthews Medicaid Director Department of Public Health and Human Services 111 North Sanders, Room 301 P.O. Box 4210 Helena, Montana 59604-4210

Dear Ms. Matthews:

Under Section 1115 of the Social Security Act (the Act), the Secretary of Health and Human Services (HHS) may approve any experimental, pilot, or demonstration project that, in the judgment of the Secretary, is likely to assist in promoting the objectives of certain Act programs including Medicaid. Congress enacted section 1115 of the Act to ensure that federal requirements did not “stand in the way of experimental projects designed to test out new ideas and ways of dealing with the problems of public welfare recipients.” S. Rep. No. 87-1589, at 19 (1962), as reprinted in 1962 U.S.C.C.A.N. 1943, 1961. Section 1115 of the Act allows the Secretary to waive compliance with the Medicaid program requirements of section 1902 of the Act, to the extent and for the period he finds necessary to carry out such demonstration project. In addition, section 1115 of the Act allows the Secretary to provide federal financial participation for demonstration costs that would not otherwise be considered as federally matchable expenditures under section 1903 of the Act, to the extent and for the period prescribed by the Secretary.

For the reasons discussed below, the Centers for Medicare & Medicaid Services (CMS) is approving Montana’s request for an extension of its section 1115 family planning demonstration, entitled “Montana Plan First,” (Project Number 11-W-00276/8). Approval of this extension is granted under the authority of section 1115(a) of the Social Security Act and is based on the determination that the expenditure authority granted therein is likely to assist with promoting the objectives of title XIX of the Act by improving access to high-quality family planning services that produce positive health outcomes for individuals. This approval is effective for ten years as of the date of this letter through, December 31, 2028. This ten year approval is contingent upon the state’s compliance with the demonstration application and eligibility process requirements described in special term and condition (STC) paragraphs 18 and 19. As noted in the document, CMS reserves the right to withdraw demonstration authority if the state fails to comply with these requirements.

Our approval of this demonstration extension is subject to the enclosed STCs and the limitations specified in the list of expenditure authorities and title XIX requirements made not applicable.