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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 amendment is to align the Alternative Benefit Plan with the Medicaid state plan by adding pharmacies as supervisors for Community Health Workers. This SPA also updates the ABP to add peer support services, Drug Medi-Cal Organized Delivery Systems SUD treatment, and mobile crisis teams.
Summary: This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by allowing FQHCs and RHCs to bill for encounters by licensed professional clinical counselors and associate professional clinical counselors.
Summary: This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by adding doula services and updates the Federally Qualified Health Centers (FQHC) and Rural Health Clinic (RHC) services category to include associate marriage and family therapist (AMFT) services and associate clinical social worker (ACSW) services.
Summary: This amendment proposes to align the Alternative Benefit Plan with the Medicaid state plan by adding asthma prevention services, community health worker services, and coverage of routine patient costs in clinical trials.
Summary: This amendment will align the Medicaid State Plan with federal law for prior authorizations and prompt payment and will bring California into compliance with the Consolidated Appropriations Act of 2022 (Public Law 117-103).
Summary: This amendment is to update the plan to broaden coverage of nursing services in schools by removing the requirement that nursing services be listed in an to Individualized Education Program (IEP), as well as amend the tobacco cessation counseling services to include that these services must be provided by a licensed practitioner.
Summary: This plan amendment updates the list of government-operated hospitals subject to specified reimbursement methodologies for inpatient hospital services.
Summary: This plan amendment updates California's All Patient Refined Diagnosis Related Group (APR-DRG) payment parameters for state fiscal year 2024-2025.
Summary: This plan amendment renews and modifies the reimbursement rate methodology for Freestanding Skilled Nursing/Subacute Facilities Level-B, by authorizing aggregate increases to the weighted average Medi-Cal reimbursement rate components for labor and non-labor costs and authorizing a new Workforce Standards Program rate augmentation.
