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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: Changes the effective date of eligibility for all eligibility groups except Qualified Medicare Beneficiaries from the date of eligibility/application to the first day of the month of eligibility application under the Medicaid State plan.
Summary: This SPA proposes to implement presumptive eligibility conducted by hospitals in the Medicaid state plan in accordance with the Affordable Care Act.
Summary: This SPA adds Erie County Medical Center to the list of Eligible Providers regarding supplemental payments to5certain professional practitioners. These supplemental payments are applicable only to the professional component of the eligible services provided.
Summary: This SPA is to limit allowable pre-eligibility medical expenses applied to reduce recurring income for long term care services to expenses incurred in the three months prior to the month of the Medicaid application.
Summary: Proposed to use 51 percent of the Federal Poverty Level (FPL) for the Modified Adjusted Gross Income (MAGI) standard for individuals eligible through the reasonable classification groups under 42 CFR 435.222 rather than the fixed dollar standards previously used. This is the same percentage used by the federally facilitated marketplace when assessing Medicaid eligibility for this group. Use of the FPL percentage income test will provide a more seamless coordination with the health care marketplace and reduce the administrative complexity of making eligibility determinations.
Summary: This SPA establishes the income standards for the specific MAGI eligibility groups and the mandatory MAGI eligibility groups for Parents and Other Caretakers, Pregnant Women, Infants and Children Under Age 19, and Former Foster Care Children up to Age 26.
