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Pennsylvania Keystones of Health Section 1115 Demonstration Approval Period: December 26, 2024 through December 31, 2029 Page 19 of 90 demonstration years not to exceed this demonstration period and the state may claim the remaining amount in a subsequent demonstration year. Table 1. Annual Limits of Total Computable Expenditures for Reentry Demonstration Initiative Planning and Implementation Program

DY 1 DY 2 DY 3 DY 4 DY 5 Total Computable Expenditures $44,768,868

$44,768,868

$44,768,868

$14,922,956

$0 c. Reentry Demonstration Initiative Planning and Implementation funding will receive the applicable administrative match for the expenditure. d. Qualified Applicants for the Reentry Demonstration Initiative Planning and Implementation Program will include the state Medicaid Agency, correctional facilities, other state agencies supporting carceral health, Probation Offices, and other entities as relevant to the needs of justice-involved individuals, including health care providers, as approved by the state Medicaid agency. 6. HEALTH-RELATED SOCIAL NEEDS DEMONSTRATION INITIATIVE 6.1. Health-Related Social Needs (HRSN) Services. The state may claim FFP for expenditures for certain qualifying HRSN services identified in STC 6.2 and Attachment G, subject to the restrictions described below. Expenditures are limited to expenditures for items and services not otherwise covered under Title XIX, but consistent with Medicaid demonstration objectives that enable the state to continue to increase the efficiency and quality of care. All HRSN interventions must be evidence-based and medically appropriate for the population of focus based on clinical and social risk factors. The state is required to align clinical and health- related social risk criteria across services and with other relevant, non-Medicaid social support agencies, to the extent possible and appropriate. The HRSN services may not supplant any other available funding sources such as housing or nutrition supports available to the beneficiary through other local, state, or federal programs. The HRSN services will be the choice of the beneficiary; a beneficiary can opt out of HRSN services anytime; and the HRSN services do not absolve the state or its managed care plans, as applicable, of their responsibilities to make payment for other covered services. Under no circumstances will the state be permitted to condition Medicaid coverage, or coverage of any benefit or service, on a beneficiary’s receipt of HRSN services. The state must submit additional details on covered services as outlined in STC 6.10 (Service Delivery) and Attachment G. 6.2. Allowable HRSN services. The state may cover the following HRSN services: a. Case management services for access to housing (e.g., outreach and education; linkages to other state and federal benefit programs, benefit program application assistance, and benefit program application fees). b. Housing interventions, including: