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A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.
When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.
Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.
Summary: To adopt the changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Pub. L. No. 115-217, section 1002.
Summary: The purpose of this state plan amendment is to add Community-Based Care Management (CBCM) Services by Opioid Use Disorder Centers of Excellence (COEs).
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow individuals who are evacuated or absent from the state due to the public health emergency and who intend to return to the state to continue to be residents of the state, extend eligibility redetermination timeframes for certain beneficiaries to 12 months, waive certain cost-sharing for COVID-19 related services, adjust certain state plan benefits, extend timelines for submission to CMS of cost reconciliation and settlement for school-based providers, and allow for the payment of additional therapeutic leave days for nursing facilities.
Summary: Continuous eligibility allowing children under the age of 4 to maintain Medicaid coverage for a full year, even if families experience a change in income or household size.
Summary: Implements Pennsylvania's Asset Verification System (AVS), for the purposes of determining and re-determining Medicaid eligibility for the aged, blind, and disabled population.
Summary: Using the Income Determination from another Means-Tested Public Benefit Programs to Support Medicaid Determinations." PA-16-0031 proposed to use the Supplemental Nutrition Assistance Program (SNAP), at initial application and renewal, and the LIHEAP program, at initial application, to support Medicaid income eligibility determinations under the Centers for Medicare and Medicaid Services' (CMS) guidance issued on August 31, 2015 (SHO #15-001).
Summary: "Individuals Eligible for Family Planning Services," the State elects to cover individuals who are not pregnant, and have household income at or below a standard established by the State, whose coverage is limited to family planning and related services and in accordance with provisions described at 42 CFR 435.214.
