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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: 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.
Summary: To amend the provisions in the LA Medicaid State Plan governing Federally Facilitated Marketplace eligibility determinations to become an "assessment" state and only accept eligibility accessment from the FFM rather than accepting Medicaid eligibility determinations made by the FFM.
Summary: Adds presumptive eligibility for parents and other caretaker relatives, pregnant women, infants and children under age 19, adult group, former foster children, and individuals eligible for family planning services; and Expands the definition of qualified providers to include acute care hospitals, psychiatric hospitals, community mental health centers, federally qualified health centers, rural health centers and local health departments.
