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South Carolina’s demonstration waiver seeks to implement a new program, Palmetto Pathways to Independence, to provide a 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. The demonstration 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, the Palmetto Pathways to Independence program will establish a new eligibility pathway for adults aged 19-64 who otherwise meet eligibility criteria under the PCR coverage group and have an income that is above 67% and up to 95% FPL with a 5% disregard, effectively including individuals between 67%-100% FPL. In addition, in order to qualify for this new eligibility pathway, individuals must also meet community engagement activity standards 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. Demonstration-eligible individuals will be required to participate in community engagement activities in order to gain Medicaid coverage and continue to participate in community engagement activities in order to maintain an active Medicaid enrollment status in this waiver. Work and community engagement requirements of this nature are not new in South Carolina, as individuals enrolled in the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) benefit programs are already required to meet similar stipulations as a condition of eligibility. To ease the administrative burden on both the state and members, the Department intends to align the participation requirements of the Palmetto Pathways to Independence program, where possible, with the work-search, education, and training opportunities available through other publicly funded programs. Qualifying community engagement activities 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, as a full or part-time student. Full or part-time student is defined as one who participates in at least 12 hours per semester (or equivalent) or for part-time students, a total of at least 12 hours over the course of two completed semesters during a 12-month period that shows a participant is achieving the state unit’s academic standards; • 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 as a full or part-time student. Full or part-time student is defined as one who participates in at least 12 hours per semester (or equivalent) or for part-time students, a total of at least 12 hours over the course of two completed semesters during a 12-month period that shows a participant is achieving the state unit’s academic standards; 6