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Medicaid State Plan Amendments

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.

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Showing 1 to 8 of 8 results
Transmittal Number: PR-24-0003
State: Puerto Rico
Summary: To update the territory’s premiums and cost-sharing payment tracking process.
Approval Date:
Effective Date:
Topics:
  • Cost Sharing
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: PR-23-0009
State: Puerto Rico
Summary: Proposes eliminating all cost-sharing except for copays associated with pharmacy and non-emergency use of the Emergency Room.
Approval Date:
Effective Date:
Topics:
  • Cost Sharing
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: ME-20-0020
State: Maine
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, allow evacuated individuals to continue to be residents, suspend co-payment obligations for certain services, suspend premiums for all beneficiaries, add coronavirus-related benefits (lab test, telehealth and pharmacy exceptions), provide reimbursement for lab tests and telehealth, increase reimbursement for private non-medical institutions and supplemental payments for hospitals.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Eligibility
  • Cost Sharing
  • Financing & Reimbursement
  • Benefits
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: PR-16-0002
State: Puerto Rico
Summary: Requires certain Medicaid beneficiaries to share in the costs of providing medical assistance through premiums and cost sharing.
Approval Date:
Effective Date:
Topics:
  • Cost Sharing
  • Financing & Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: PR-13-004
State: Puerto Rico
Summary: Changes the service limits for comprehensive tobacco cessation services provided to pregnant women including both counseling and pharmacotherapy, without cost sharing.
Approval Date:
Effective Date:
Topics:
  • Benefits
  • Cost Sharing
  • Eligibility
  • Prescription Drugs
  • Program Administration
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: ME-12-015
State: Maine
Summary: Amends the Cost Sharing sections of the State's approved Title XIX State Plan to permit Retail and Specialty Pharmacy Services providers to require, as a condition for providing care, items, or services, the payment of any cost sharing.
Approval Date:
Effective Date:
Topics:
  • Cost Sharing
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: PR-11-003
State: Puerto Rico
Summary: Cost Sharing.
Approval Date:
Effective Date:
Topics:
  • Cost Sharing
  • Financing & Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: ME-10-003
State: Maine
Summary: To encourage dual eligible beneficiaries to more fully utilize Medicare cost-sharing benefits available through the Medicare Savings Program.
Approval Date:
Effective Date:
Topics:
  • Cost Sharing
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT