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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: This amendment target zero cost sharing to individuals in any eligibility group who are eligible for extended postpartum coverage under section 1902(e)(16) of the Social Security Act.
Summary: To update state plan language related to the coordination of benefits for hospital services and remove obsolete rules-based language that is no longer pertinent.
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 attest that the state covers COVID-19 vaccine, testing, and treatment without cost sharing.
Summary: This amendment modifies the reimbursement received at an Indian Health Services or Tribal 638 provider for a Medicaid member with dual eligible benefits. The Medicare payment will be treated as third party payments and be offset against the all-inclusive Medicaid payment.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to suspend all cost sharing.
Summary: Allows health plans to require cost sharing for certain beneficiaries under managed care. This carries over a policy for the same group under the state's fee-for-service programs, and as such will not increase costs or utilization.
Summary: This Amendment continues authorization for Graduate Medical Education (GME) payments made on behalf of individuals enrolled in the New Jersey CW Demonstration in the amount of $218,000,000 for state fiscal year (SFY) 2022.
