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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: CMS is approving this state plan amendment to respond to the COVID-19 national emergency. The purpose of this SPA is to rescind the optional eligibility group in Section A.1 that was previously approved in an earlier COVID-19 emergency state plan amendment.
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 expand entities qualified to make presumptive eligibility determinations, all for adjustments to benefits currently covered in the state plan (e.g. Personal Care Assistant Services; Care Management Organization Targeted Case Management Staffing), expand telehealth, adjust prior authorizations for medications, decrease certain payments (quarterly rather than monthly basis), expand bed hold limits due to COVID, and alteration of Behavioral Health Home travel protocols.
Summary: This state plan amendment establishes an Alternative Benefit Plan to serve persons eligible for Medicaid under Section 1902(a)(10)(A)(VIII) of the Social Security Act. This plan will offer Basic benefits equal to the current State Plan benefits offered in the state minus adult dental, vision, and over the counter drugs.
Summary: This state plan amendment establishes an Alternative Benefit Plan to serve persons eligible for Medicaid under Section 1902(a)(10)(A)(VIII) of the Social Security Act. This plan will offer Prime benefits equal to the current State Plan benefits offered in the state.
Summary: Updates to the paper application, and the state’s election to use an alternative single, streamlined application developed by the state for individuals applying for coverage who may be eligible based on the applicable modified adjusted gross income standard
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, and remove language that requires Pediatric Day Healthcare Center (PDHC) closure in order for families to receive services in a residential setting.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow for hospital presumptive eligibility for a number of optional groups and authorizes 2 PE periods within a calendar year while waiting performance standards during the emergency. This SPA also waives all copays during the emergency. These changes also apply to the approved Alternative Benefit Plan. The SPA allows for broad use of telehealth with reimbursement based on the current face-to-face fee schedule. Prior authorization for medications and Preferred Drug List exceptions are modified under this SPA.
