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Approval Period: April 1, 2019 through December 31, 2028 Page 9 of 28

The state will provide 12 months of continuous eligibility, and not require reporting of changes in income or household size for this 12-month period, for an individual found to be eligible for this demonstration upon initial application or annual redetermination.

Enrollment in this demonstration is capped at 4,000 individuals.

18. Eligibility Determination Process. Application and enrollment processes for this demonstration must comply with section 1943 of the Act and implementing regulations at 42 CFR part 435. Transition to full compliance must be completed no later than March 31, 2022.

a) Mitigation Work Plan and Timeline. The state must submit for CMS review and approval a work plan describing the changes the state will make to its demonstration application and enrollment processes that meet the intent of section 1943 of the Act and regulations at 42 CFR part 435 (referred to herein as mitigations) and the timeline for implementing the mitigations. The work plan must be submitted to CMS by a date mutually agreed to by CMS and the state. The state must implement all mitigations no later than 90 days after a date mutually agreed to by CMS and the state through the mitigation work plan review and approval. The mitigation work plan must address each of the following areas: i) Application ii) Notices iii) Redetermination iv) Verification, and v) Coordination with other Insurance Affordability Programs.

b) Systems coordination and full compliance with section 1943 and implementing regulations at 42 CFR part 435. The state must achieve compliance with section 1943 of the Act and implementing regulations at 42 CFR part 435. The state must specifically address the following issues: coordination between the family planning program and the full benefit Medicaid program application processes such that individuals can file a single application to be considered for all bases of eligibility; integrating family planning eligibility into the state’s Medicaid eligibility hierarchy; redetermining a beneficiary’s Medicaid eligibility on all bases of eligibility and without re-application; and conducting verification in accordance with 42 CFR 435.916. The state must be in full compliance with applicable statute and regulations no later than March 31, 2022. i) Documentation. The state must notify CMS in writing when it achieves full compliance with applicable statute and regulations. This notification must include documentation to demonstrate the state’s compliance. ii) CMS Review. Upon receipt of the documentation in STC 18(b)(i), CMS will review the information and work with the state to verify compliance with applicable statute and regulations.

A delay in implementing the processes necessary to align with section 1943 of the Act (and implementing federal regulations at 42 CFR part 435) may subject the state to the penalty described in STC 10.