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Medicaid State Plan Amendments

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.

Results

Displaying 1 - 10 of 15867

Mississippi

This amendment allows the Division of Medicaid (DOM) to update the calculation of the Prescribed Pediatric Extended Care (PPEC) rates to use the 2023 average small nursing facility rates.

Approval Date: August 14, 2025
Effective Date: May 1, 2025

Hawaii

This amendment modifies coverage of dental services to include dental providers who see individuals with intellectual/developmental disabilities (I/DD) and challenging behaviors and to include coverage of non-fluoride agents.

Approval Date: August 12, 2025
Effective Date: April 1, 2025

New Hampshire

This amendment proposed to increase the Medically Needy income limit.

Approval Date: August 11, 2025
Effective Date: July 1, 2025
Topics: Eligibility Medicaid and CHIP Program (MACPro)

Hawaii

This amendment revises the language concerning nursing facility services to comport with the requirement that nursing facility services are ordered by and provided under the direction of a physician.

Approval Date: August 7, 2025
Effective Date: May 1, 2025

North Carolina

This amendment proposes to confirm the state's compliance with Section 5121 of the 2023 Consolidated Appropriations Act (CAA) to provide screening, diagnostic, and targeted case management services to eligible juveniles as defined in 1902(nn) of the Social Security Act.

Approval Date: August 7, 2025
Effective Date: January 1, 2025
Topics: Coverage Eligibility Targeted Case Management

Virginia

This amendment eliminates the requirement for Consumer Directed Services Facilitators to have an associate's or bachelor's degree to provide services. Work experience shall be listed as sufficient in the list of requirements.

Approval Date: August 5, 2025
Effective Date: July 1, 2025

California

This plan amendment rescinds the alternative payment methodology (APM) for Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Tribal Health Programs (THPs) when COVID-19 vaccines are administered on their own and outside of a billable visit.

Approval Date: August 4, 2025
Effective Date: October 1, 2024

Illinois

This SPA describes coverage and adds per diem reimbursement for private duty nursing care for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) beneficiaries.

Approval Date: July 31, 2025
Effective Date: January 1, 2025

Delaware

This plan amendment updates the methodology for pediatric nursing facility care pediatric facility care currently applies only for members up to age 21.

Approval Date: July 30, 2025
Effective Date: January 1, 2025

Kansas

This plan amendment adds the reimbursement rate for Women, Infants and Children (WIC) supplement.

Approval Date: July 30, 2025
Effective Date: May 1, 2025