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• WOW expenditures, or baseline expenditures, represent the amount the federal government would have spent in the absence of the demonstration and form the basis for the budget neutrality expenditure limit. • WW expenditures, or actual expenditures, are the projected costs under the demonstration. In accordance with CMS guidance, for the budget neutrality calculation associated with the community engagement population, hypothetical costs are used to estimate WOW expenditures for the 1115 Palmetto Pathways to Independence waiver program since these members are not currently enrolled in Medicaid. In other words, these expenditures are based on anticipated costs rather than historical data. For purposes of the budget neutrality, Medicaid rates were applied to anticipated utilization for the PMPM projections. Additional details on the budget neutrality calculation can be found in Appendix A. Enrollment The table below illustrates year one through year five enrollment projections for the Palmetto Pathways to Independence waiver population. The estimated enrollment is reflective of unique members per year and includes an enrollment cap of 11,400 members. Table 3: Palmetto Pathways to Independence Waiver Projected Enrollment The base eligible population includes South Carolina residents ages 19-64 who are PCRs with income above 67% and up to 100% of the FPL. The American Community Survey (ACS) census data from the U.S. Census Bureau for South Carolina for calendar year (CY) 2023 was utilized to project the base population eligible for the Palmetto Pathways to Independence waiver program. The ACS data provided information regarding the number of PCR with and without health insurance by FPL and has been adjusted to reflect actual enrollment in Healthy Connections Medicaid and private health insurance. Additionally, emerging enrollment was reviewed to understand the impact of the public health emergency and recent regulations by insurance coverage. The individuals eligible for Medicaid under the Palmetto Pathways to Independence waiver program are not assumed to be currently eligible for Medicaid in South Carolina. The following assumptions were applied to the base eligible population: Take-up rate The take-up rate reflects the percentage of the eligible Palmetto Pathways to Independence waiver population expected to enroll in the program. The take-up rate by insurance coverage was based on a review of historical Medicaid participation rates and current unemployment levels, which are at historically low levels. The take-up rates for eligible Medicaid members who are known Medicaid recipients to the South Carolina program, such as members who have exhausted their Transitional Medicaid Assistance (TMA) coverage, pregnant women whose coverage has terminated at the end of the 12 month postpartum period, or individuals enrolled in the Family Demonstration Years (DY) DY 01 DY 02 DY 03 DY 04 DY 05 Estimated Enrollment 5,280

8,930

10,736

11,391

11,400

Estimated Member Months 63,358 107,160 128,832 136,692 136,800 12