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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 allows for 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. Administration (FDA), during drug shortages.
Summary: This plan amendment proposes to increase the reimbursement rate for all vaccine administration services for both pediatrics and adults and to clarify and consolidate the payment parameters for vaccine administration.
Summary: This amendment is to increase the monthly needs allowance for individuals living in certain long-term care facilities from $50 to $75 for individuals and $100 to $150 for couples.
Summary: This amendment is to suspend temporarily pharmacy co-payments for dates of service starting February 21, 2024, through March 18, 2024, in response to the Change Healthcare cybersecurity incident in alignment with the CMCS Informational Bulletin.
Summary: This amendment is to add Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) to the list of professions that are accepted as Medicaid providers for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) as required by the Consolidated Appropriations Act 2023.
Summary: This amendment proposed to adopt the 12-month continuous eligibility mandate for children, extend the initial transitional medical assistance (TMA) period from six months to 12, and elect the option to require less than three months of eligibility or enrollment in the parent/caretaker relative eligibility group for TMA eligibility.
