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CMS has written to state Medicaid directors to explain that while it has approved several section 1115(a) demonstrations that provide federal matching funds for state expenditures for designated state health programs (DSHP) and designated state investment programs (DSIP), it has reviewed those programs and determined that they were funded entirely without federal Medicaid funds prior to those approvals and the addition of federal Medicaid funding does not render these programs as integral components of section 1115 demonstration programs

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