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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 is to update state plan assurances in accordance with the federally mandated requirements for the Child Core Set and the behavioral health quality measure on the Adult Core Set outlined in 42 CFR 431.16 and 437.10 through 437.15.
Summary: This amendment is to comply with the requirements of section 5112 of the Consolidated Appropriations Act of 2023. The territory seeks CMS approval (1) to provide continuous eligibility for hospitalized children until the end of a child's inpatient stage if the child would have remained eligible but for having turned 19; and (2) to provide continuous eligibility for children for 12 months or until the child turns 19.
Summary: This amendment establishes compliance with the mandatory coverage and reimbursement of routine patient costs associated with participation in qualifying clinical trials under Sections 1905(a)(30) and 1905(gg) of the Social Security Act.
Summary: This amendment clarifies the assurance that Guam provides EPSDT services pursuant to sections 1902(a)(10)(A), 1905(a)(4)(B), and 1905(r) of the Social Security Act.
Summary: This SPA implements coverage of the new mandatory benefits of COVID 19 Vaccines and Administration of the Vaccines, Diagnostic and Screening Tests, and Treatment, Specialized Equipment and Therapies, and Preventive Therapies in accordance with the requirements of Section 9811 of the American Rescue Plan (ARP) Act.
Summary: This SPA will update Third Party Liability (TPL) requirements as authorized under the Bipartisan Budget Act (BBA) of 2018 and the Medicaid Services Investment and Accountability Act (MSIAA) of 2019.
Summary: This amendment is to increase an income disregard for an optional eligibility group serving individuals who are 65 years old or older or who have blindness or a disability.
Summary: This SPA adopts the option to provide Medicaid eligibility without a 5-year waiting period to otherwise eligible individuals who lawfully reside in Guam in accordance with the Compacts of Free Association (COFA) between the Government of the United States and the Governments of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau
Summary: Effective January 1, 2021, this amendment increases the local poverty level (LPL) such that the MAGI income standards of 138% of the LPL is equivalent to 150 percent of the federal poverty level (FPL).
