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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 SPA describes the methodology used by the state for determining the appropriate FMAP rates, including the increased FMAP rates, available under the provisions of the Affordable Care Act applicable for the medical assistance expenditures under the Medicaid program associated with enrollees in the new adult group adopted by the state and described in 42 CFR 435.119.
Summary: This SPA allows the state to comply with the Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act.
Summary: Nebraska will join a Consortium to develop an AVS and will enter into a contract with the New England States Consortium System Organization to meet the federal requirements in implementing an AVS, using a contractor to provide data to assist in verifying asset information for all individuals who have SSI-related eligibility.
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: This amendment continues the reimbursement system for acute care general hospitals using all patient refined-diagnosis related groups and amends the calculation of relative values to a national basis versus the previously used state of NY's relative values as the basis.
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.
Summary: Eliminates the requirements that the dependent child must be deprived of parental support or care as a requirement of eligiblity for the Parent/Caretaker Relative group; to use 58% of the FPL as the income limit for this group rather then the fixed dollar amounts previously used.
Summary: Proposed to provide coverage for qualified youth age 19 but less than 21 who entered into a kinship guardianship assistance agreement, an adoption assistance agreement, or a state-funded guardianship assistance agreement after turning age 16, who also meet at least one of several work or school requirements, using the state's AFDC payment standards as of 7/16/1996 for the income limit.
Summary: Describes Methodology Used by the State for Determining Appropriate FMAP Rates, Including the Increased FMAP Rates, Available Under the Provisions of the Affordable Care Act Applicable for the Medical Assistance Expenditures Under the Medicaid Program Associated with Enrollees in the New Adult Group Adopted by the State.
Summary: This SPA describes the methodology used by the state for determining the appropriate FMAP rates, including the increased FMAP rates, available under the provisions of the Affordable Care Act applicable for the medical assistance expenditures under the Medicaid program associated with enrollees in the new adult group adopted by the state.