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Medicaid State Plan Amendments

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.

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Showing 11 to 20 of 531 results
Transmittal Number: WA-24-0043
State: Washington
Summary: This plan amendment updates the outdated information about Small Rural Indigent Assistance Disproportionate Share Hospital payments and clarify references to Medicaid clients.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: WA-24-0041
State: Washington
Summary: This amendment is to revise out-of-date transplant coverage policies to conform to industry standards and government practices to the Medicaid State Plan.
Approval Date:
Effective Date:
Topics:
  • Coverage
Links:
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Transmittal Number: PR-24-0009
State: Puerto Rico
Summary: This SPA adds home health and hospice services for adults and updates the language under the Other Licensed Practitioners benefit. Additionally, the state clarified that benefits for the medically needy are the same as those for the categorically needy.
Approval Date:
Effective Date:
Topics:
  • Coverage
  • Benefits
  • Home Health
  • Other Licensed Practitioners
Links:
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Transmittal Number: PR-24-0007
State: Puerto Rico
Summary: Describes services for the adult expansion population, including home health, durable medical equipment, hospice, and non-emergency transportation services, to ensure that benefits for this population align with those for the rest of the adult population.
Approval Date:
Effective Date:
Topics:
  • Alternative Benefit Plan
Links:
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Transmittal Number: WA-24-0026
State: Washington
Summary: This amendment is to add Community Health Workers as Providers of Preventative Services to the Medicaid State Plan.
Approval Date:
Effective Date:
Topics:
  • Coverage and Reimbursement
Links:
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Transmittal Number: WA-24-0039
State: Washington
Summary: This plan amendment updates the case mix data source from the Resource Utilization Groups (RUGs) to the Patient-Driven Payment Model (PDPM).
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: PR-24-0013
State: Puerto Rico
Summary: Update on the general limitations, lab, and family planning services.
Approval Date:
Effective Date:
Topics:
  • Coverage and Reimbursement
Links:
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Transmittal Number: WA-24-0040
State: Washington
Summary: This plan amendment updated the effective date of the fee schedules for Home and Community Based Services (HCBS).
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: PR-24-0008
State: Puerto Rico
Summary: This SPA amends the provision to authorize coverage of select weight loss drugs when medically necessary.
Approval Date:
Effective Date:
Topics:
  • Obesity Drugs
Links:
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Transmittal Number: WA-24-0013
State: Washington
Summary: This amendment is to add Behavioral Health Support Specialists as providers to the Medicaid State Plan.
Approval Date:
Effective Date:
Topics:
  • Coverage
  • Other Licensed Practitioners
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT