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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 SPA modifies the language provisions for coverage of weight loss drugs as outlined on the Wisconsin Medicaid Drug Search Tool found on the state’s website.
Summary: This amendment for Tailored Care Management is to increase the Health Home payment rate for higher acuity beneficiaries and to provide assurances of mandatory Core Set measures.
Summary: Adds licensed professional counselors and licensed marriage and family therapists to the core services proved by Federally Qualified Health Centers and Rural Health Clinics. The amendment also added pharmacists and licensed dietician-nutritionists to the list of other ambulatory services offered by Federally Qualified Health Centers and Rural Health Clinics.
Summary: This amendment updates language for excluded drugs covered by SCDHHS including weight loss medicine, prescription vitamins & minerals and OTC drugs.
Summary: Pursuant to state legislation that rescinds Medicaid coverage and payment provisions for outpatient health facilities (OHF), this SPA proposes to remove the obsolete Attachment 3.1-A and 4.19-B pages from the Medicaid State Plan.
Summary: This amendment for Clinic Services addresses the compliance concerns raised in the February 24, 2023 companion letter, for an April 1, 2023, effective date.
