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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.

Results

Displaying 121 - 130 of 15690

Alaska

This SPA allows Alaska to enter into value/outcome-based contracts with pharmaceutical manufacturers on a voluntary basis.

Approval Date: March 13, 2025
Effective Date: January 1, 2025
Topics: Value Based Purchasing

American Samoa

This amendment adds on and off-island outpatient dialysis services to within dialysis clinics and Free standing ESRD clinics. Additionally, this amendment makes technical edits to dental services in the state plan.

Approval Date: March 13, 2025
Effective Date: October 1, 2024
Topics: Coverage and Reimbursement

North Carolina

This amendment proposes to remove the medically monitored detoxification services from rehabilitative services benefit. This level of care will be provided in inpatient settings, aligning with the ASAM levels of care outlined in the state's 1115 SUD demonstration.

Approval Date: March 12, 2025
Effective Date: January 1, 2025
Topics: Coverage Preventive Services Reimbursement

Massachusetts

This amendment adds doula service coverage for adoptive parents of infants.

Approval Date: March 12, 2025
Effective Date: November 8, 2024
Topics: Coverage Preventative Services

New Jersey

This SPA allows New Jersey to enter into Value-Based Supplemental Rebate Agreements with drug manufacturers on a voluntary basis.

Approval Date: March 11, 2025
Effective Date: October 1, 2024
Topics: Value Based Purchasing

New Jersey

This SPA allows coverage of select prescribed drugs that do not meet the definition of covered outpatient drugs. Additionally, this SPA also allows reimbursement of prescribed drugs with the same reimbursement methodologies as covered outpatient drugs.

Approval Date: March 11, 2025
Effective Date: October 1, 2024
Topics: Covered Outpatient Drug Prescribed Drugs Reimbursement

Puerto Rico

Clarifications and updates to the Prepaid Inpatient Health Plan and fraud detection language.

Approval Date: March 11, 2025
Effective Date: October 1, 2024

South Dakota

This amendment proposed a two-year extension of the exception from establishing a Medicaid Recovery Audit Contractor (RAC) program.

Approval Date: March 10, 2025
Effective Date: June 1, 2024
Topics: Program Administration

Wisconsin

The amendment added intensive outpatient treatment services.

Approval Date: March 10, 2025
Effective Date: November 1, 2024

District of Columbia

This amendment is to renew the District of Columbia's 1915(i) State Plan HCBS benefit.

Approval Date: March 10, 2025
Effective Date: April 1, 2025
Topics: Benefits Coverage and Reimbursement Eligibility Home and community based services