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Approval Period: October 1, 2022 – September 30, 2027 Amended November 14, 2024 3

• Have one or more substance use disorders, • Have serious mental illness, • Eligible for Medicaid funded 1915(c) home and community-based services administered by the Office of Long-Term Living or Office of Developmental Programs, • With one or more chronic health conditions, • Are pregnant or in the 12-month postpartum period, or • With Autism Spectrum Disorder.

1.3 Eligibility Exclusions: The following adults and children are excluded from receiving continuous eligibility: a. Have only established Medicaid eligibility as medically needy (as set forth in section 1902(a)(10)(C) of the Act), b. Have been determined presumptively eligible for Medicaid but have not yet received an eligibility determination based on a regular application, or c. Upon the adult and child’s renewal are determined to only be eligible for Medicaid based on transitional medical assistance (as set forth in section 1925 of the Act).

1.4 Exceptions to Continuous Eligibility: Notwithstanding STC 1.2, if any of the following circumstances occur during an individual’s designated continuous eligibility period, the individual’s Medicaid eligibility shall be redetermined or terminated: a. The beneficiary attains the age limit of the continuous eligibility period or eligibility group (if applicable); b. The beneficiary is no longer a Commonwealth of Pennsylvania resident; c. The beneficiary or their representative requests termination of eligibility; d. The beneficiary dies; e. The agency determines that eligibility was erroneously granted at the most recent determination, redetermination, or renewal of eligibility because of agency error or fraud, abuse, or perjury attributed to the individual.

1.5 Beneficiary-Reported Information and Periodic Data Checks: a. The state must have procedures designed to ensure that beneficiaries can make timely and accurate reports of any change in circumstances that may affect their continuous eligibility as outlined STC 1.4 (such as a change in state residency) and are able to report other information relevant to the state’s implementation or monitoring and evaluation of this demonstration, such as changes in income. The beneficiary must be