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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: Clarifies coverage of diabetes self-management training services as dieticians’ services and reflects a change in terminology from “lactation counseling services” to “lactation consultation services.”
Summary: This amendment is to cover the optional eligibility group described in 42 C.F.R. 435.218 ("Individuals with MAGI-based income above 133 percent FPL") and serve in it children under 19 whose incomes are no greater than 318 percent of the federal poverty level and who may have other insurance.
Summary: This amendment moves the Applied Behavior Analysis (ABA) services from the Rehabilitative Services – Mental Health and Substance Abuse section to the Preventive Services Section of the plan with a reference in the Early Periodic Screening Diagnosis and Treatment (EPSDT) services to Preventive services.
Summary: This ABP updates the coverage limit for diagnostic, preventative, and restorative dental services for adults aged 21 and older, excluding cosmetic services. It also aligns non-EHB adult dental coverage with changes approved in WV-24-0002.
Summary: This amendment allows licensed outpatient hospitals, with Center for Medicare and Medicaid approved hospital accreditation, to apply to become adult day treatment providers.
Summary: This amendment proposes to update the coverage limit for dental services for adults aged 21 and older for diagnostic, preventative, and restorative services, excluding cosmetic services.
Summary: This amendment updates Physician Assistant Services, Screening, Brief Intervention, Referral and Treatment Services Providers, and Collaborative Care Services Providers to the Medicaid State Plan.
Summary: This amendment adds coverage for the human papillomavirus (HPV) vaccine for persons 46 years of age or older who meet certain medical criteria.
