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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: apply a census income disregard for Medicaid eligibility groups subject to non-MAGI income methodology, and to migrate eligibility requirements already approved for those non-MAGI eligibility groups into the state plan. Additionally, this state plan amendment revises the MAGI
Summary: Designates entities that furnish health care items and services covered under the state plan as qualified entities to make presumptive eligibility determinations for the family planning group
Summary: increases the maximum age to 21 for individuals who are involved in or at serious risk of involvement with the juvenile justice system; and align targeted case management services with current evidence-based practices
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to suspend copayments for all adult enrollees for all services, and make specific temporary changes to the home health benefit (supplies and equipment) and requirements for referrals from primary care.
Summary: Amends the State Plan to remove page T1 from the State Plan which allowed North Dakota to conduct presumptive eligibility for the month of January 2014.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to rescind the election of the COVID optional eligibility group.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. This second Medicaid Disaster Relief SPA for North Carolina includes temporary modifications to benefit and payment provisions during the emergency declaration period. The state is proposing the following temporary rate increases: 1) a 10% rate increase for certain providers facing a disproportionate impact during the pandemic, 2) a 5% general increase to all providers that have not yet received one as required by the State’s General Assembly, and 3) authority to provide payments to pharmacy providers for mail-prescriptions to reduce direct contact for beneficiaries and providers.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment to 1) allow Hospital Presumptive Eligibility (HPE) for individuals aged 65 and over who have income under 100% of the Federal Poverty Level, 2) eliminate copays for acute inpatient hospital stays for all members, and 3) eliminate cost sharing for all COVID-19 testing and treatment services.
