Page 12

8 Demonstration Approval: November 1, 2023, through October 31, 2028

16. Eligibility for the Demonstration. Individuals eligible for this demonstration are limited to “out-of-state former foster care youth” who are defined as individuals under age 26 that meet the following criteria:

a) were in foster care under the responsibility of a state other than South Dakota or a tribe in such other state when they turned age 18 (or such higher age as the state has elected for termination of Federal foster care assistance under title IV-E of the Act); b) were enrolled in Medicaid at the time of aging out of foster care; c) turned 18 on or before December 31, 2022; d) are now applying for Medicaid in South Dakota; and, e) are not otherwise eligible for Medicaid.

17. Benefits and Cost-sharing provided under the Demonstration. Out-of-state former foster care youth will receive the same Medicaid State Plan benefits and be subject to the same cost-sharing requirements effectuated by the state for the mandatory title IV-E foster care youth eligibility category enacted by the Adoption Assistance and Child Welfare Act of 1980 (Pub. L. 96-272).

18. Delivery System. Enrollees in this demonstration will receive services through the state's managed care delivery system.

V. MONITORING AND REPORTING REQUIREMENTS

19. Deferral for Failure to Submit Timely Demonstration Deliverables. CMS may issue deferrals in accordance with 42 CFR part 430 subpart C, in the amount of $5,000,000 per deliverable (federal share) when items required by these STCs (e.g., required data elements, analyses, reports, design documents, presentations, and other items specified in these STCs (hereafter singularly or collectively referred to as “deliverable(s)”)) are not submitted timely to CMS or are found to be inconsistent with the requirements approved by CMS. A deferral shall not exceed the value of the federal amount for the demonstration. The state does not relinquish its rights provided under 42 CFR part 430 subpart C to challenge any CMS finding that the state materially failed to comply with the terms of this agreement. The following process will be used: 1) 30 days after the deliverable was due if the state has not submitted a written request to CMS for approval of an extension as described in subsection (b) below; or 2) 30 days after CMS has notified the state in writing that the deliverable was not accepted for being inconsistent with the requirements of this agreement and the information needed to bring the deliverable into alignment with CMS requirements:

a) CMS will issue a written notification to the state providing advance notification of a pending deferral for late or non-compliant submission of required deliverable(s). For each deliverable, the state may submit to CMS a written request for an extension to submit the required deliverable that includes a supporting rationale for the cause(s) of the delay and the state’s anticipated date of submission. Should CMS agree to the state’s request, a corresponding extension of the deferral process can be provided.