Medicaid State Plan Amendments

This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by adding Medication Therapy Management (MTM) under Pharmacist Services.

This amendment will align the Medicaid State Plan with federal law for prior authorizations and prompt payment and will bring California into compliance with the Consolidated Appropriations Act of 2022 (Public Law 117-103). 

This amendment adds Therapeutic Foster Care to Iowa’s Medicaid State Plan as a Rehabilitative Service.

This SPA allows Wisconsin to enter into Value-Based Supplemental Rebate Agreements with drug manufacturers on a voluntary basis.

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. Additionally, this SPA authorizes reimbursement of prescribed drugs that are not considered covered outpatient drugs, with the same reimbursement methodologies as covered outpatient drugs.

This Amendment disregards state tax refunds, rebates, and credits, and certain teacher stipends, in determining eligibility for certain non-MAGI eligibility groups.

This amendment is to adopt the optional eligibility group described in section 1902(a)(10)(A)(ii)(XIII) of the Social Security Act, which serves working individuals who have disabilities and incomes below 250 percent of the federal poverty level.

The purpose of this amendment is to renew Delaware's 1915 State Plan HCBS benefit. The effective date for this renewal is January 1, 2025. This SPA is approved for five years expiring December 31, 2029, in accordance with 1915(7) of the Social Security Act.

This amendment extends the exception for the Recovery Audit Contractor (RAC) Program for an additional two-year period.

This amendment discontinues health homes from the alternative benefit plan.