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Pennsylvania Keystones of Health Section 1115 Demonstration Approval Period: December 26, 2024 through December 31, 2029 Page 80 of 90 ATTACHMENT G HRSN Services Matrix

Pennsylvania 1115 HRSN Services Matrix Service Category Service SMI SUD Pregnant or Postpartum Acute Cancer with Active Chemo- Therapy High-Risk Pregnancy Diet-sensitive chronic health condition High-Risk Chronic health condition Autism Spectrum Disorder Housing/Home Environment interventions without room and board Case management for housing X X X X X X X Housing navigation and tenancy

support* X X X X X X X One-time transition and moving costs other than rent X X X X X X X Utility assistance X X X X X X X Housing interventions with Room and Board (Rent Only Interventions) First month’s rent, as a transitional service X X X X X X X Short-term rental assistance X X X X X X X Nutrition interventions with food Home Delivered meals X Medically Tailored Meals X X X *Includes Housing transition and navigation services, Pre-tenancy navigation services, and Tenancy sustaining services