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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: Effective January 1, 2021, this amendment adopts a new resource disregard under the authority of section 1902(r)(2) of the Social Security Act. The agency chooses to provide a reasonable timeframe for reducing excess resources accumulated during the COVID-19 public health emergency (PHE) by certain individuals subject to the post-eligibility treatment of income (PETI) rules for long-term services and supports (LTSS). Under FFCRA, these individuals accumulated extra resources, due to no changes being made to their PETI. Income they would have otherwise paid toward the cost of their care resulted in an increase in their resources that began to exceed program standards. This methodology also will prevent an institutionalized beneficiary from having to spend down any such excess resources during the PHE. This methodology will remain in effect through the twelve months following the end of the COVID-19 PHE.
Summary: Effective January 1, 2021, this amendment updates the CarePlus Alternative Benefit Plan (ABP) to reflect additional covered dental services for adults.
Summary: Effective January 17, 2021, this amendment includes coverage, limitations, and payment for services when services are provided by a Pharmacist.
Summary: This amendment will allow for Case Management Services to be billed for High Intensity Care Coordination for each eligible recipient in the family, each month, according to each recipient’s unique needs.
Summary: Effective January 1, 2021, this amendment adjusts the dental benefit to include crowns and certain endodontic services including root canals and apicoectomies as covered services for beneficiaries 21 years and older.
Summary: Effective April 1, 2020, this amendment proposes to provide Medicaid coverage of durable medical equipment to support beneficiaries' mobility-related activities of daily living.
Summary: Effective August 19, 2020 this amendment adds coverage and reimbursement for three evidence-based parenting programs for children with disruptive behavior disorders.
Summary: This amendment proposes adding coverage and payment methodology of Personal Care Attendant Services (PCAP) in the U.S. Virgin Islands Medicaid program, approved initially on March 25, 2021. At the time of approval, the end of the PHE was not known. Now that the date is known, this SPA has been updated to reflect an effective of May 12, 2023.
