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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 provides assurance in Attachment D that the benefit package provided for all individuals through the postpartum extension complies with section 1937 of the Act, including the provision of essential health benefits (EHBs) and that no treatment limitations that are more restrictive than the Alternative Benefit Plan (ABP).
Summary: To apply disregards, under the authority of section 1902(r)(2) of the Social Security Act, in determining eligibility for certain non-MAGI groups for settlement payments related to the February 3, 2023, train derailment in East Palestine, Ohio.
Summary: Clarifies coverage of diabetes self-management training services as dieticians’ services and reflects a change in terminology from “lactation counseling services” to “lactation consultation services.”
Summary: Revises the state plan to allow an incentive payment for coverage of private rooms in nursing facilities when specific facility criteria are met.
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.
Summary: This plan amendment simplifies payment methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) dispensed by a pharmacy.
