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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: Purpose of the SPA is to align state plan authority for managed care, with the 1915(b) amendment approved on August 25, 2015. SPA No. 15-0004 requires mandatory enrollment into physical health for children with special healthcare needs eligible through a subsidized adoption; individuals eligible for coverage through the Breast and Cervical Cancer Prevention program, and carves in hospice services and non-emergency transportation provided by ambulances into the physical health benefits package for the special needs children and American Indians/Alaskan Native populations. The SPA notes that effective July 1, 2015, the MCO contracts awarded effective July 1, 2015, were procured through sole sourcing. Lastly, this SPA updated language that references "mental retardation" to now reflect "intellectual disability".
Summary: Proposed to provide coverage for qualified youth age 19 but less than 21 who entered into a kinship guardianship assistance agreement, an adoption assistance agreement, or a state-funded guardianship assistance agreement after turning age 16, who also meet at least one of several work or school requirements, using the state's AFDC payment standards as of 7/16/1996 for the income limit.
Summary: Proposed to increase the fixed dollar amount for Parent/Caretaker Relatives and includes an update to the maximum income standard which will increase the amount each year according to the Consumer Price Index for urban consumers.
Summary: Disregards an amount equal to premiums paid for private/commercially available health insurance when determining the eligibility of persons in the Qualified Medicare Beneficiaries, Specified Low-income Medicare Beneficiaries, Qualifying Individuals, Working Disabled, or Aged and Disabled eligibility groups.
Summary: This amendment increases aggregate payment rates by 2.25% for nursing facility and intermediate care facility for individuals with intellectual disabilities services.
