An official website of the United States government
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.
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 temporarily income disregard to allow Puerto Rico Medicaid Program to temperately increase the effective monthly income standard for the Optional Categorically Needy ABD Group and all Medically Needy Groups.
Summary: Update the PCCM program to allow individuals to change their PCP without cause, and mandates enrollment for 19 and 20-year-old individuals who are eligible under Medicaid expansion.
Summary: To update policies regarding how Medicaid applications may be submitted, the frequency and methods used for renewal of eligibility, requirements when determining ineligible assistance with application and renewal notice requirements and the use of authorized representatives.
lower the WHODAS assessment eligibility score requirement from 50 to 25 to increase the number of potential participants,
permit the use of medical records as an additional verification option for completing program eligibility forms,
increase rates for Training and Support for Unpaid Caregivers and Community Transition services, and
reduce provider qualifications for services to expand the provider pool in the state.
Summary: This amendment expands the number of acceptable ICD_10 Diagnoses for individual with the diagnosis of brain injury, behavioral health condition and/or substance abuse disorder.
Summary: This SPA removed pages that were left in the State Plan in error; by vacating coverage pages for Targeted Case Management for Individuals with a Traumatic Brain Injury and Targeted Case Management for Individuals in Pre - or Post - Adoption.
