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March 27, 2025 Catawba Indian Nation Attn: Chief Brian Harris 996 Avenue of the Nations Rock Hill, South Carolina 29730 sou ...... c;. iOUNA D[PARTM(NfOf HEALTH ,\ND :-iu•-\A,\/ SERVl('£S - Healthy Connections • MEDICAID,. Henry McMaster GOVERNOR Eunice Medina DIRECTOR P.O. Box 8206 > Columbia, SC 29202 www.scdhhs.gov Subject: Community Engagement Section 1115 Demonstration Waiver Dear Chief Harris: On behalf of the state of South Carolina, and in keeping with the responsibility to conduct tribal consultation, I am writing to inform you that the South Carolina Department of Health and Human Services (SCDHHS) intends to submit a Section 1115 Demonstration Waiver to the Centers for Medicare and Medicaid Services (CMS). The Section 1115 Demonstration Waiver will create a new coverage pathway for families whose income is currently too high to qualify for Medicaid but too low to qualify for federal subsidies in the federal marketplace. Specifically, this demonstration waiver, the Palmetto Pathways to Independence program, will provide a new eligibility pathway for individuals who meet the definition of parent caretaker relative (PCR) and have an income that is at or above 67% of the federal poverty level (FPL) and up to 95% FPL with a 5% disregard. This will effectively include individuals between 67 and 100% of FPL. The demonstration seeks to build a state-specific solution to eliminate the financial disincentives for employment that currently exist due to the Patient Protection and Affordable Care Act's (ACA) all-or-nothing approach to Medicaid expansion by allowing certain families to continue to receive Medicaid coverage until they reach an income of 100% of FPL and become eligible for subsidized federal marketplace coverage. In order to qualify for this new eligibility pathway, individuals must meet community engagement activity requirements by participating in a qualifying activity for a minimum of 80 hours per month. Since the intent of the waiver is to remove disincentives for employment that exist in the current program for Medicaid-enrolled parents and caretaker relatives, maintaining employment or other forms of community engagement is a critical component of the Palmetto Pathways to Independence program. Community engagement activities will include: • Employment for no less than 80 hours per month. • Participation in an adult secondary education program through a public school district or technical college, including vocational education and training programs. • Participation in a degree- or certificate- seeking program in an accredited institution of higher education, as defined by the South Carolina Commission on Higher Education. • Compliance with Unemployment Insurance (UI) work-search requirements (first 16 weeks of U I benefits). • For dual Medicaid-SNAP/TANF members, demonstrated compliance with SNAP community engagement standards. South Carolina Department of Health and Human Services V Better care. Better value. Better health. 32