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State Plan Flexibilities

Medicaid State Plan Disaster Relief State Plan Amendments

In response to a public health emergency or disaster, states may wish to revise policies in their Medicaid state plan related to eligibility, enrollment, benefits, premiums and cost sharing, and/or payments. For example, states may elect to use Presumptive Eligibility for expedient enrollment of individuals into coverage. During an emergency or disaster, the Medicaid agency can act as the qualified entity conducting presumptive eligibility determinations.

In March 2020, the Centers for Medicare & Medicaid Services (CMS) created a Medicaid State Plan Amendment (SPA) template (DOCX, 35.8 KB) and instructions (PDF, 264.69 KB) to assist states in responding to the COVID-19 national emergency. This streamlined SPA template combines multiple, time-limited state plan options into one single template, eliminating the need to submit multiple SPA actions.

CHIP Disaster Relief SPAs

States can submit CHIP State Plan Amendments (SPAs) (PDF, 188.43 KB)  that allow for temporary adjustments to enrollment and redetermination policies during disaster events. The purpose is to implement provisions for temporary adjustments to enrollment and redetermination policies and cost sharing requirements for children in families living and/or working in Governor or FEMA declared disaster areas. In the event of a natural disaster, the State will notify CMS that it intends to provide temporary adjustments to its enrollment and/or redetermination policies and cost sharing requirements, the effective and duration date of such adjustments, and the applicable Governor or FEMA declared disaster areas.