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December 26, 2024

Sally Kozak Deputy Secretary Office of Medical Assistance Programs 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 a five-year section 1115 demonstration (Project Number 11-W- 00484/3), in accordance with section 1115(a) of the Social Security Act (“the Act”). This approval is effective as of December 26, 2024, through December 31, 2029, upon which date, unless extended or otherwise amended, all authorities granted to operate this demonstration will expire.

CMS has determined that Pennsylvania’s Keystones of Health demonstration is likely to assist in promoting the objectives of the Medicaid statute by increasing access to high-quality medical assistance and improving health outcomes for beneficiaries.

Approval of this demonstration provides expenditure authority for limited coverage for certain services furnished to certain incarcerated individuals for up to 90 days immediately prior to the individual’s expected date of release. Approval of this demonstration also provides expenditure authority for new initiatives related to promoting services addressing health-related social needs (HRSN). With this demonstration, Pennsylvania is introducing new initiatives and investments to assist the state in improving health coverage, access, and consistent provision of high-quality services for Medicaid beneficiaries, while additionally making important gains in advancing health equity among its beneficiary populations.

CMS’s approval of this section 1115(a) demonstration is subject to the limitations specified in the attached waiver and expenditure authorities, special terms and conditions (STC), and any supplemental attachments defining the nature, character, and extent of federal involvement in this project. The state may deviate from the Medicaid state plan requirements only to the extent those requirements have been specifically listed as waived or not applicable to expenditures under the demonstration.

Extent and Scope of the Demonstration

Approval of Pennsylvania’s Keystones of Health demonstration includes the following initiatives: (1) Reentry and (2) HRSN. The overall goals of this demonstration include: