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DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-25-26 Baltimore, Maryland 21244-1850 October 30, 2023 Brenda Tidball-Zeltinger Director, Division of Medical Services South Dakota Department of Social Services 700 Governors Drive, Kneip Building Pierre, SD 57501-2291 Dear Director Tidball-Zeltinger: The Centers for Medicare & Medicaid Services (CMS) is approving South Dakota’s (the “state”) request for a five-year extension of the demonstration titled, “South Dakota Former Foster Care Youth” (FFCY) (Project Number 11-W-00319/8)) (the “demonstration”), in accordance with section 1115(a) of the Social Security Act (“the Act”). This approval is effective from November 1, 2023, through October 31, 2028, upon which date, unless extended or otherwise amended, all authorities granted to operate this demonstration will expire. CMS’s approval is subject to the limitations specified in the attached expenditure authority, special terms and conditions (STC), and any supplemental attachment defining the nature, character, and extent of federal involvement in this project. The state may deviate from Medicaid state plan requirements only to the extent those requirements have been listed as not applicable to expenditures under the demonstration. Extent and Scope of Demonstration Extension South Dakota’s FFCY demonstration has been effective since May 2018. By CMS approving this extension request, the demonstration will continue to provide authority for FFCY under age 26, who currently reside in South Dakota, but were enrolled in Medicaid in a different state or tribe when they "aged out" of the foster care system. Section 1002(a) of the SUPPORT Act created a new Former Foster Care Children (FFCC) Medicaid state plan eligibility group, providing coverage for individuals who were receiving Medicaid while in foster care under the responsibility of any state; however, the new requirements apply exclusively to those who turn 18 on or after January 1, 2023.1 As a result, states still need section 1115 demonstration authority to continue coverage for individuals who turned 18 years old before January 1, 2023, until a beneficiary reaches age 26. Therefore, South Dakota’s FFCY demonstration eligibility will be limited to beneficiaries who turned 18 on or before December 31, 2022. 1 2022 State Health Official Letter. https://www.medicaid.gov/federal-policy-guidance/downloads/sho22003.pdf