STATE OF HAWAII DEPARTMENT OF HUMAN SERVICES MED-QUEST DIVISION PUBLIC NOTICE Pursuant to 42 C.F.R. §447.205, the Department of Human Services (DHS), Med-QUEST Division (MQD) hereby notifies the public that the MQD intends to submit a State Plan Amendment to the Centers for Medicare and Medicaid Services (CMS). Under provisions of federal law, the state is required to issue public notice of proposed changes in statewide methods and standards for setting Medicaid payment rates. The State Plan Amendment (SPA) proposes to create a new eligibility group. This group, also identified under the “Ticket to Work and Work Incentives Improvement Act” authority, allows individuals with a disability at least 19 years of age but less than 65 years of age whose countable income is below 138% of the Federal Poverty Level and resource standard equal to three (3) times the SSI resource limit adjusted annually the increase in the consumer price index for the applicable Household size. The SPA is posted at https://medquest.hawaii.gov/en/about/state-plan-1115.html. SPA 21-0004 is expected to have minimal effect on the annual aggregate expenditures. The proposed change will be submitted for review to the federal government as a Medicaid State Plan Amendment (SPA) to be effective December 31, 2020. Comments should be received within 30 days from the time this notice is posted. Individuals may submit written comments using the following methods: By email: emauricio@dhs.hawaii.gov (Please identify in the subject line: State Plan Amendment 21-0004) By mail: Department of Human Services Med-QUEST Division Attention: Policy and Program Development Office P.O Box 700190 Kapolei, Hawaii 96709 A copy of the proposed changes is available for public viewing from the first working day the public notice appears in the Honolulu Star-Advertiser, Hawaii Tribune Herald, West Hawaii Today, The Maui News, and The Garden Island. A printed copy of the proposed changes and special accommodations (i.e., interpreter, large print or taped materials) can be arranged if requested by contacting the Policy and Program Development Office at (808) 692-8058 no later than seven (7) working days before the comment period ends. DEPARTMENT OF HUMAN SERVICES, MED-QUEST DIVISION JUDY MOHR PETERSON, PhD MED-QUEST DIVISION ADMINISTRATOR (WHT1308337 12/30/20)