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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.

Results

Displaying 1 - 10 of 15755

Louisiana

This State Plan Amendment requests an extension of the exemption from participation in the Recovery Audit Contractor (RAC) program.

Approval Date: June 4, 2025
Effective Date: August 6, 2025
Topics: Program Administration

New Hampshire

This plan updates the rates and clarifies methodology language for laboratory services, radiology services, and durable medical equipment (DME).

Approval Date: June 4, 2025
Effective Date: January 1, 2025

Connecticut

This plan amendment updates the Community First Choice (CFC) program to comply with the Collective Bargaining Agreement (CBA).

Approval Date: June 4, 2025
Effective Date: January 1, 2025

North Carolina

This plan amendment revises hospital readmission review requirements from 30 days to 72 hours to align with Clinical Policy.

Approval Date: June 4, 2025
Effective Date: January 1, 2025

Michigan

This plan amendment aligns the Non-Emergency Transportation (NEMT) mileage rate with the Internal Revenue Service (IRS) Standard Business rate.

Approval Date: June 4, 2025
Effective Date: May 1, 2025

Connecticut

This amendment provides updates to the states excluded drug listing.

Approval Date: June 3, 2025
Effective Date: June 1, 2025
Topics: Excluded Drug Coverage

Nevada

Tlris Slate Plan adds Community Health Representartives as a reimbursable prnvider only through a Tribal Health Clinic operating under the Indian Self-Determinations and Education Act of 1975 (PL 93-638).

Approval Date: June 3, 2025
Effective Date: January 1, 2025
Topics: Coverage and Reimbursement

Texas

This plan amendment updates High-Cost Clinician Administered Drugs and Biologics (HCCADs), Human Breast Milk Processing Storage and Distribution, and Long-Acting Reversible Contraceptive devices to pay outside the all patient refined diagnosis-related group inpatient reimbursement.

Approval Date: June 3, 2025
Effective Date: June 1, 2025

Wyoming

This SPA provied an exemption to the State requirements to contract with a Medicaied Recovery Audit Contractor from July 1, 2025 - June 30, 2027.

Approval Date: June 2, 2025
Effective Date: July 1, 2025
Topics: Program Administration

Missouri

This amendment adds a daily reimbursement amount for services provided at a licensed Prescribed Pediatric Extended

Approval Date: June 2, 2025
Effective Date: August 28, 2025
Topics: Coverage and Reimbursement