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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

November 14, 2024

Sally Kozak Deputy Secretary Pennsylvania Department of Human Services 625 Forster Street, Room 333 Harrisburg, PA 17120

Dear Deputy Secretary Kozak,

The Centers for Medicare & Medicaid Services (CMS) is approving the Commonwealth of Pennsylvania’s request for an amendment to the “Medicaid Coverage Former Foster Care Youth from a Different State & Substance Use Disorder (SUD)” section 1115 demonstration (Project Number 11-W-00308/3), in accordance with section 1115(a) of the Social Security Act (the “Act”). Approval of this request will provide expenditure authority to allow the state to provide continuous eligibility to children up to age six, from birth through the end of the month in which their sixth birthday falls and high-risk formerly incarcerated children and adults for 12 months. The state originally submitted this request as part of an application for a new demonstration, titled “Bridges to Success: Keystones of Health for Pennsylvania (Keystones of Health)”. However, the state’s request for authority to provide continuous eligibility is being approved as an amendment to the “Medicaid Coverage for Former Foster Care Youth from a Different State and (SUD)” section 1115 demonstration to allow the state to implement continuous eligibility while CMS and Pennsylvania continue discussions on the other elements of the state’s pending demonstration request. The authority is effective from the date of this approval and will remain in effect through the rest of the demonstration approval period, which is set to expire September 30, 2027.

CMS’s approval of this section 1115(a) demonstration amendment is subject to the limitations specified in the attached expenditure authority, special terms and conditions (STCs), and any supplemental attachments defining the nature, character, and extent of federal involvement in this project. The STCs in Attachment G of this letter should be considered as part of the broader set of STCs that were approved on October 1, 2022 for the Medicaid Coverage Former Foster Care Youth from a Different State & SUD section 1115 demonstration and will be incorporated into the full STCs at the next approval action for this demonstration. All continuous eligibility requirements in statue and regulations, as well as CMS guidance explaining continuous eligibility apply to this demonstration, unless the governing expenditure authorities and STCs state that a particular rule or policy does not apply.

Extent and Scope of Demonstration Amendment