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June 23, 2025 Robert F. Kennedy, Jr. Secretary U.S. Department of Health and Human Services 200 Independence Avenue, SW Washington, D.C. 20201 Dear Secretary Kennedy: On behalf of the state of South Carolina, I am submitting to the U.S. Department of Health and Human Services (HHS) the enclosed Section 1115 demonstration waiver application to implement community engagement standards that will also serve to close the health care coverage gap created by the Patient Protection and Affordable Care Act (ACA) and incentivize employment among its citizens. This demonstration waiver seeks to build a state-specific solution to eliminate the financial disincentives for employment that currently exist due to the ACA’s all or nothing approach to Medicaid expansion. Specifically, this demonstration will support strategies to: • Remove health-related barriers to employment; • Promote member transition to commercial health insurance; and • Support the long-term, fiscal sustainability of the Healthy Connections Medicaid program. Thank you for your thoughtful consideration of this waiver and for your demonstrated commitment to the people of South Carolina. Your very truly, Henry Dargan McMaster