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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 amendment is to add School-Based Services, which allows the State Medicaid Agency to reimburse local education agencies (LEAs) for providing health related services to Medicaid eligible students in a school-based setting.
Summary: This SPA eliminates the “deprivation” requirement relating to dependent children living with individuals who seek Medicaid on the basis or being parents and other caretaker relatives.
Summary: This amendment is to comply with mandatory Medicaid coverage of routine patient costs furnished in connection with participation in qualifying clinical trials.
Summary: This amendment complies with the requirements for assurance of Medicaid coverage for non-emergency medically-related transportation in accordance with Section 209 of the Consolidated Appropriations Act of 2021.
Summary: Adjust the reimbursement methodology for nursing facilities to align with the Medicare Patient Driven Payment Model (PDPM), incentivize quality care and staffing levels, and include a $70 million annual quality incentive payment tied to Long Stay STAR ratings.
Summary: This amendment is to allow licensed clinical professional counselors and licensed marriage and family therapists to enroll in Medicaid and bill fee-for-service.
Summary: Approved the State’s request to amend its State Plan to add a new 1915 Home and Community Based Services (HCBS) benefit. As part of the SPA, Illinois revised its 3.1-F pages, which authorizes Managed Care under 1932(a) to include the new 1915 program.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to temporarily eliminate the "Deprivation" requirement relating to dependent children living with individuals who seek Medicaid on the basis of being parents and other caretaker relatives.
Summary: Transitions Illinois children enrolled through the sperate CHIP Program to Medicaid expansion coverage through the Optional Targeted Low Income Children eligibility group.
