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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 1 - 10 of 15857

Delaware

This plan amendment updates the methodology for pediatric nursing facility care pediatric facility care currently applies only for members up to age 21.

Approval Date: July 30, 2025
Effective Date: January 1, 2025

Kansas

This plan amendment adds the reimbursement rate for Women, Infants and Children (WIC) supplement.

Approval Date: July 30, 2025
Effective Date: May 1, 2025

Pennsylvania

This plan amendment increases the funding for disproportionate share hospital (DSH) payments to qualifying acute care general hospitals that provide enhanced access to multiple types of medical care in economically distressed areas of the Commonwealth.

Approval Date: July 30, 2025
Effective Date: June 15, 2025

Indiana

This Amendment updates the state plan assurances in accordance with federally mandated quality reporting requirements for the Child Core Set and the behavioral health quality measures on the Adult Core Set outlined in 42 CFR 431.16 and 437.10 through 437.15.

Approval Date: July 25, 2025
Effective Date: April 1, 2025
Topics: Medicaid and CHIP Program (MACPro)

Oregon

This amendment confirms that Oregon allows retroactive enrollment of eligible providers.

Approval Date: July 25, 2025
Effective Date: July 1, 2025

Arizona

This amendment proposes an update to the Standards for Coverage of Organ Transplant Services to include small bowel transplant
as a covered service for adults aged 21 years and older.

Approval Date: July 24, 2025
Effective Date: October 1, 2025

Tennessee

This amendment provides updates to the state's limitations on the amount, duration, and scope of coverage for prescribed drugs, and updates the state's excluded drug list.

Approval Date: July 23, 2025
Effective Date: August 1, 2025
Topics: Excluded Drug Coverage Prescribed Drugs Prescription Limitations Weight Loss Drugs

Virginia

This SPA amends the Medicaid State Plan to provide for mandatory coverage in accordance with section 1902(a)(84)(D) of the Social Security Act for eligible juveniles who are incarcerated in a public institution post-adjudication of charges. This SPA is effective on January 1, 2025, and will sunset on December 31, 2026.

Approval Date: July 21, 2025
Effective Date: January 1, 2025
Topics: Coverage Eligibility Targeted Case Management

Washington

The purpose of this SPA is to add the “Reentry Targeted Case Management (TCM)” service to the list of services in Attachment 3.1-F Part 2, page 21. The SPA also updates the section and page numbers of the “Medication for Opioid Use Disorder (formerly known as Medication Assisted Treatment (MAT)” service.

Approval Date: July 21, 2025
Effective Date: July 1, 2025

Kentucky

This SPA amends the Medicaid State Plan to provide for mandatory coverage in accordance with section 1902(a)(84)(D) of the Social Security Act for eligible juveniles who are incarcerated in a public institution post-adjudication of charges. This SPA is effective on January 1, 2025, and will sunset on December 31, 2026.

Approval Date: July 18, 2025
Effective Date: January 1, 2025
Topics: Coverage Eligibility Reimbursement Targeted Case Management