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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 SPA allows coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the U.S. Food and Drug Administration (FDA), during drug shortages. In addition, this SPA proposes to reimburse prescribed drugs that are not considered covered outpatient drugs utilizing the same methodologies as covered outpatient drugs.
Summary: This amendment adds coverage for the human papillomavirus (HPV) vaccine for persons 46 years of age or older who meet certain medical criteria.
Summary: Recognizes the shift to require managed care plans to cover transportation to all Medicaid-covered services, clarifies coverage language, and reflects other technical adjustments.
Summary: This SPA implements coverage of the Advisory Committee on Immunization Practices' recommended vaccines for adult Medicaid beneficiaries without cost sharing, in compliance with Section 11405 of the Inflation Reduction Act of 2022.
Summary: This SPA updates the professional qualifications for technicians delivering Adaptive Behavior Support services to Medicaid beneficiaries diagnosed with autism spectrum disorder.
Summary: This amendment updates the Alternative Benefit Plan to provide authority to recognize Community Health Workers (CHWs) as Medicaid providers of necessary CHW services.
