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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 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 temporarily suspends beneficiary cost sharing for pharmacy claims with dates of service from February 22, 2024 to June 30, 2024. The terms of this State Plan Amendment sunset at midnight on June 30, 2024.
Summary: This amendment complies with the Consolidated Appropriations Act of 2022 and makes changes to the state plan so that health insurance companies cannot deny reclamation claims for the Agency not obtaining prior authorization for the item or service through the health insurance company and requiring health insurance companies to process reclamation claims within 60 days of receipt of such claims.
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.
Summary: This plan amendment updates the list of government-operated hospitals subject to specified reimbursement methodologies for inpatient hospital services.
Summary: This amendment moves the Applied Behavior Analysis (ABA) services from the Rehabilitative Services – Mental Health and Substance Abuse section to the Preventive Services Section of the plan with a reference in the Early Periodic Screening Diagnosis and Treatment (EPSDT) services to Preventive services.
