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Approval Period: April 1, 2019 through December 31, 2028 Page 2 of 28

package consisting only of family planning services and family planning-related services.

3. Retroactive Coverage Section 1902(a)(34)

To the extent necessary to enable the state to not provide medical assistance to the demonstration population for any time prior to when an application for the demonstration is made.

4. Early and Periodic Screening, Diagnostic, and Treatment Section 1902(a)(43)(A) (EPSDT)

To the extent necessary to enable the state to not furnish or arrange for EPSDT services to the demonstration populations.

5. Prospective Payment for Federally Qualified Health Centers Section 1902(a)(15) and Rural Health Centers and Rural Health Clinics

To the extent necessary for the state to establish reimbursement levels to these clinics that will compensate them solely for family planning and family planning related services.

6. Eligibility Procedures

Section 1902(a)(17)

To the extent necessary to allow the state to not require reporting of changes for income or household size for 12 months, for a person found income-eligible upon application or annual redetermination when determining eligibility for the family planning demonstration.

6. Reasonable Promptness

Section 1902(a)(8)

To enable the state to utilize an enrollment limit for the demonstration population.