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Approval Period: October 1, 2022 – September 30, 2027 Amended November 14, 2024 2

consistent with 42 CFR 435.916 and 435.919 for individuals who qualify for continuous eligibility until the end of the individual’s continuous eligibility period, except in the limited circumstances of a beneficiary meeting one of the exceptions outlined in STC 1.4. c. At the end of the continuous eligibility periods, the Commonwealth of Pennsylvania must conduct a renewal of Medicaid eligibility and consider eligibility on all bases consistent with 42 CFR 435.916(d)(1) prior to terminating coverage. Individuals determined eligible on another basis at the end of the continuous eligibility period will be moved to the appropriate group at that time. Individuals determined eligible on another basis resulting in a reduction of Medicaid eligibility or services or increase in cost sharing or premiums will be provided advance notice of termination in accordance with 42 CR 435.917 and 42 CFR 431, Subpart E. Individuals determined ineligible for Medicaid on all bases will be provided advance notice of termination in accordance with 42 CR 435.917 and 42 CFR 431, Subpart E and assessed for potential eligibility for other insurance affordability program in accordance with 42 CFR 435.916(d)(2).

1.2 Populations and Duration: The state is authorized to provide continuous eligibility for the following populations for the associated durations. a. Children up to age six. Except as provided in STC 1.4, individuals age zero through the end of the month of their sixth birthday, who enroll in Medicaid shall qualify for continuous eligibility until the end of the month in which their sixth birthday falls. b. Formerly Incarcerated. Except as provided in STC 1.4, the state is authorized to provide 12 months of continuous eligibility for individuals aged 19 – 65 who are released from a state correctional institution and meet one or more of the following criteria for high risk: i. Have one or more substance use disorders, ii. Have serious mental illness, iii. Eligible for Medicaid funded 1915(c) home and community-based services administered by the Office of Long-Term Living or Office of Developmental Programs, iv. With one or more chronic health conditions, v. Are pregnant or in the 12-month postpartum period, or vi. With Autism Spectrum Disorder. The period of continuous eligibility shall begin at the date of their release and will extend through the end of the 12th month following release. Table 1: Eligible Populations and Associated Duration for Continuous Eligibility (CE) Population Duration of CE Children up to age 6 Until the end of the month of their 6th birthday Beneficiaries leaving incarceration (aged 19 - 65) and meet one or more of the following criteria for high risk: Up to 12 months following their release from a state correctional facility