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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 31 to 40 of 366 results
Transmittal Number: SD-23-0022
State: South Dakota
Summary: This amendment proposes to exempt children with non-Title IV-E adoption assistance under age 21 and individuals under age 21 with an income above 133% of the federal poverty level from the PCCM program.
Approval Date:
Effective Date:
Topics:
  • Managed Care
Links:
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Transmittal Number: SD-23-0012
State: South Dakota
Summary: The SPA proposes to move South Dakota Medicaid from the Resource Utilization Group Ill (RUG Ill) reimbursement model to the Patient Driven Payment Model (PDPM) reimbursement model for Nursing Facility services.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: SD-23-0019
State: South Dakota
Summary: This amendment covers adult vaccinations and their administration without cost sharing.
Approval Date:
Effective Date:
Topics:
  • Coverage
Links:
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Transmittal Number: VT-23-0015
State: Vermont
Summary: This amendment proposes to assure coverage of adult vaccines per the Inflation Reduction Act and coverage of preventive services.
Approval Date:
Effective Date:
Topics:
  • Coverage
  • Vaccine
Links:
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Transmittal Number: SD-23-0018
State: South Dakota
Summary: This Amendment expands Hospital Presumptive Eligibility (HPE) to include the Adult Medicaid Expansion group.
Approval Date:
Effective Date:
Topics:
  • Medicaid and CHIP Program (MACPro)
  • Eligibility
Links:
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Transmittal Number: SD-23-0015
State: South Dakota
Summary: This SPA authorizes increased federal financial participation (FFP) for newly-eligible individuals receiving postpartum coverage and further includes the addition of Attachment D, which describes the special circumstances and other proxy adjustments that are applied to account for the proportion of individuals covered under the extended postpartum coverage option who would otherwise be eligible for coverage in the adult group and for the newly eligible FFP under section 1905(y) of the Social Security Act;
Approval Date:
Effective Date:
Topics:
  • Coverage and Reimbursement
Links:
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Transmittal Number: VT-23-0039
State: Vermont
Summary: This amendment specifies that select incontinence supplies must be supplied by the statewide contracted vendor unless prior authorized.
Approval Date:
Effective Date:
Topics:
  • Coverage
  • Home Health
  • Other Licensed Practitioners
Links:
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Transmittal Number: VT-23-0041
State: Vermont
Summary: This Alternative Benefit Plan (ABP) adds Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT) and Paramedic provider types to ensure coverage authority for ambulance treatment without transport.  This aligns the state’s ABP with approved SPA 23-0037.
Approval Date:
Effective Date:
Topics:
  • ABP
  • Coverage
Links:
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Transmittal Number: VT-23-0031
State: Vermont
Summary: This SPA proposes to amend the state's excluded drug coverage listing.
Approval Date:
Effective Date:
Topics:
  • Covered Outpatient Drug
  • Coverage
  • Prescribed Drugs
  • Prescription Drugs
Links:
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Transmittal Number: VT-23-0033
State: Vermont
Summary: This amendment proposes to increase the annual dental cap for adults from $1,000 to $1,500 and to allow emergency dental services for adults to be covered after the annual cap on dental expenditures has been met.
Approval Date:
Effective Date:
Topics:
  • Coverage
  • Dental
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT