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Approval Period: October 1, 2022 – September 30, 2027 Amended November 14, 2024 6

to budget neutrality, components of budget neutrality expenditure limit calculations, and other purposes related to monitoring and tracking expenditures under the demonstration. The Master MEG Chart table provides a master list of MEGs defined for this demonstration. BN – budget neutrality; MEG – Medicaid expenditure group; WOW – without waiver; WW – with waiver BN – budget neutrality; MEG – Medicaid expenditure group; WOW – without waiver; WW – with waiver 4.2 Reporting Expenditures and Member Months. The state must report all demonstration expenditures claimed under the authority of title XIX of the Act and subject to budget neutrality each quarter on separate forms CMS-64.9 WAIVER and/or 64.9P WAIVER, identified by the demonstration project number assigned by CMS (11- W-00308/3). For the CE MEG, 2.6 percent for adults or 0.11 percent for children of expenditures are allocated to the CE MEG. Separate reports must be submitted by MEG (identified by Waiver Name) and Demonstration Year (identified by the two-digit project number extension). Unless specified otherwise, expenditures must be reported by Demonstration Year (DY) according to the dates of service associated with the expenditure. All MEGs identified in the Master MEG Chart as WW must be reported for expenditures, as further detailed in the MEG Detail for Expenditure and Member Month Reporting table below. To enable calculation of the budget neutrality expenditure limits, the state also must report member months of eligibility for specified MEGs. a. Member Months. As part of the Quarterly and Annual Monitoring Reports, the state must report the actual number of “eligible member months” and expenditures for all Table 2: Master MEG Chart MEG Which BN Test Applies? WOW Per Capita WOW Aggregate WW Brief Description CE – Children TANF/MAGI Hypo X

X All expenditures for continued benefits for children who have been determined eligible for the continuous eligibility period who would otherwise lose coverage during an eligibility determination. CE – Children SSI/HH and Other Disabled Hypo X

X All expenditures for continued benefits for children who have been determined eligible for the continuous eligibility period who would otherwise lose coverage during an eligibility determination. CE - Formerly incarcerated TANF/MAGI Hypo X

X All expenditures for continued benefits for beneficiaries leaving incarceration who meet criteria for high risk during the Continuous Eligibility period and who would otherwise lose coverage during an eligibility determination.