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

Attachment G CENTERS FOR MEDICARE & MEDICAID SERVICES Expenditure Authority NUMBER: 11-W-00308/3 TITLE: Pennsylvania Medicaid Coverage Former Foster Care Youth from a Different State & SUD AWARDEE: Pennsylvania Department of Human Services Title XIX Expenditure Authority Under the authority of section 1115(a)(2) of the Social Security Act (the Act), expenditures made by the Commonwealth of Pennsylvania for the items identified below, which are not otherwise included as expenditures under section 1903 of the Act shall, for the period of this demonstration, be regarded as expenditures under the state’s title XIX plan. The following expenditure authority must only be implemented consistent with the approved Special Terms and Conditions (STCs) and shall enable the Commonwealth of Pennsylvania to implement the section 1115 demonstration amendment. All other requirements of the Medicaid program, including current and future CMS guidance for continuous eligibility, as expressed in law, regulation, and policy statements must apply to these expenditures, unless identified as not applicable below. Continuous Eligibility. Expenditures for continued state plan benefits for individuals who have been determined eligible as specified in Table 1 of STC 1.2, who are not otherwise excluded under STC 1.3 for the applicable continuous eligibility period, and who would otherwise lose coverage during an eligibility redetermination, except as noted in STC 1.4. SPECIAL TERMS AND CONDITIONS 1. Eligibility and Enrollment

1.1 Continuous Eligibility: Eligible populations, identified in STC 1.2, will receive continuous eligibility through the demonstration. The state is authorized to provide continuous eligibility for the populations for the durations specified in Table 1 below, regardless of the delivery system through which these populations receive Medicaid benefits. a. For individuals who qualify for continuous eligibility, the continuous eligibility period begins on the effective date of the individual's eligibility under 42 CFR 435.915, the effective date of the most recent redetermination, or the date of their release from a state correctional institution. b. Because individuals are continuously eligible regardless of changes in circumstances, the state does not need to conduct renewals or redeterminations of eligibility