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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 is to adopt the changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.
Summary: Adds two adult dental and dentures services and increases flexibility in determining prior authorization requirements for diagnostic services.
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 waive signature requirements for the dispensing of drugs during the Public Health Emergency (PHE) resulting from COVID-19.
Summary: This State Plan Amendment is an exemption of the State’s requirement to contract with a Medicaid Recovery Audit Contractor. This is a time-limited SPA with an expiration date of July 1, 2025. This is a period not to exceed two (2) years.
Summary: Establishes compliance with the mandatory coverage and reimbursement of routine patient costs furnished concerning participation in qualifying clinical trials under Section 1905(gg) of the Social Security Act.
Summary: To remove the expiration date from PR SPA 21-0011 and add language to keep the Puerto Rico Local Poverty Level at 85 percent of the federal poverty level.
Summary: To remove the expiration date from PR SPA 21-0012 and modify the income disregard for certain categorically needy and medically needy eligibility groups in the Puerto Rico Medicaid program.
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.
