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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 172 results
Transmittal Number: AS-24-0001
State: American Samoa
Summary: This amendment is to temporarily suspend otherwise covered benefits for the period January 1, 2024 through September 30, 2024 in response to the territory’s local funding shortfall.
Approval Date:
Effective Date:
Topics:
  • Coverage
  • Benefits
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: DE-24-0005
State: Delaware
Summary: This amendment provides 12 months of continuous eligibility to children under age 19 enrolled in Medicaid.
Approval Date:
Effective Date:
Topics:
  • Coverage
  • Eligibility
  • Medicaid and CHIP Program (MACPro)
  • Program Administration
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: DE-23-0008
State: Delaware
Summary: This plan amendment revises the Medicaid reimbursement for ground emergency transportation services (GEMT).
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: DE-23-0007
State: Delaware
Summary: This SPA amends the State Plan to allow the State to enter into value-based contract arrangements with drug manufacturers through supplemental rebate agreements.
Approval Date:
Effective Date:
Topics:
  • Coverage
  • Coverage and Reimbursement
  • Preferred Drug Lists
  • Physician Administered Drugs
  • Prescription Drugs
  • Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: DE-23-0003
State: Delaware
Summary: This SPA updates language on the Delaware excluded drug coverage pages to reflect coverage of selective medications by referencing the state’s webpage and policy handbook resources instead of listing specific covered medications. Additionally, the SPA amends the Title XIX Medicaid State Plan regarding physician administered drug reimbursement rates.
Approval Date:
Effective Date:
Topics:
  • Coverage
  • Coverage and Reimbursement
  • Preferred Drug Lists
  • Physician Administered Drugs
  • Prescription Drugs
  • Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: DE-23-0004
State: Delaware
Summary: This amendment proposes to remove the optional service, case management of high-risk pregnant women, from the Delaware Medicaid State Plan as these services will now be provided via an evidence-based home visiting model under 1115 waiver authority, effective January 1, 2023.
Approval Date:
Effective Date:
Topics:
  • Targeted Case Management
  • Federal Financial Participation
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: DE-22-0016
State: Delaware
Summary: Ambulatory Surgical Center Services Rate
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: DE-23-0005
State: Delaware
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency.  The purpose of this amendment is to align the resumption of premiums with the end of the unwinding period and to assign dates to the temporarily extended suspension of member copays and premiums.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Eligibility
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: AS-23-0001
State: American Samoa
Summary: The purpose of this SPA to implement mandatory coverage and reimbursement of COVID-19 testing, vaccine and vaccine administration, and treatment in accordance with Section 9811 of the American Rescue Plan (ARP) Act.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Benefits
  • Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: DE-23-0002
State: Delaware
Summary: To adopt the changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Pub. L. No. 115-217, section 1002.
Approval Date:
Effective Date:
Topics:
  • Eligibility
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT