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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: This state plan amendment establishes an Alternative Benefit Plan to serve persons eligible for Medicaid under Section 1902(a)(10)(A)(VIII) of the Social Security Act. This plan will offer Basic benefits equal to the current State Plan benefits offered in the state minus adult dental, vision, and over the counter drugs.
Summary: This state plan amendment establishes an Alternative Benefit Plan to serve persons eligible for Medicaid under Section 1902(a)(10)(A)(VIII) of the Social Security Act. This plan will offer Prime benefits equal to the current State Plan benefits offered in the state.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend cost sharing for testing services, testing-related services, and treatment for COVID-19 (including vaccines, specialized equipment and therapies); Suspends premiums for Working Disabled and TMA; Allow Home health to be ordered and plans of care authorized by new provider types (Nurse Practitioner, Physician Assistant, Clinical Nurse Specialist; and Nurse Midwife); Increase the NF bedhold to 90 days provided the bed has not been filled; Add teledentistry reevaluation - post operative visit; and add codes and rates for teledentistry services added.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to suspend all cost sharing for all eligibility groups effective May 1, 2020, through the remainder of the public health emergency.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover individuals evacuated from the state or absent due to disaster, extend the reasonable opportunity period, designate new populations for presumptive eligibility to be determined by qualified entities who previously determined presumptive eligibility for Pregnant women only expanded telehealth to specific named providers; to provide new rates and billing codes for telehealth services, and provide new test codes and rates.
Summary: This SPA adds coverage for the eligibility group for adults with income below 133% of the FPL under Section 1902(a)(10)(A)(viii) of the Social Security Act
Summary: Updates the state plan to reflect existing practices in determining eligibility of persons who qualify as medically needy to update optional state supplemental payment standard, and to update the allowed exemption amount for irrevocable burial trusts.
Summary: Proposed to use 51 percent of the Federal Poverty Level (FPL) for the Modified Adjusted Gross Income (MAGI) standard for individuals eligible through the reasonable classification groups under 42 CFR 435.222 rather than the fixed dollar standards previously used. This is the same percentage used by the federally facilitated marketplace when assessing Medicaid eligibility for this group. Use of the FPL percentage income test will provide a more seamless coordination with the health care marketplace and reduce the administrative complexity of making eligibility determinations.