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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.

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Transmittal Number: NY-09-53
State: New York
Summary: Prescribing Incentive.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
  • Prescription Drugs
Links:
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Transmittal Number: NC-09-028
State: North Carolina
Summary: Outpatient Drugs - Supplemental Rebates.
Approval Date:
Effective Date:
Topics:
  • Prescription Drugs
Links:
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Transmittal Number: NY-09-52
State: New York
Summary: Dispense Brand Drugs When Less Expensive.
Approval Date:
Effective Date:
Topics:
  • Prescription Drugs
Links:
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Transmittal Number: MI-09-003
State: Michigan
Summary: This SPA proposes to place reasonable limits on the amounts of incurred necessary medical and remedial care expenses recognized under State law, but not covered under the State Plan.
Approval Date:
Effective Date:
Topics:
  • Current State Plan
  • Program Administration
Links:
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Transmittal Number: PA-10-002
State: Pennsylvania
Summary: Changes to Pharmaceutical Payment Policy/Prior Authorization of Drugs.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
  • Prescription Drugs
Links:
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Transmittal Number: TX-09-039
State: Texas
Summary: Extends the allowable number of Medicaid drug refills to 11 refills when dispensed within 12 months of the date of the original prescription.
Approval Date:
Effective Date:
Topics:
  • Prescription Drugs
  • Program Administration
Links:
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Transmittal Number: ID-09-015
State: Idaho
Summary: This SPA makes technical corrections to identify how incontinence supplies are reimbursed which reflects current practice and aligns with the current Medicare Advantage contracts.
Approval Date:
Effective Date:
Topics:
  • Current State Plan
  • Financing & Reimbursement
Links:
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Transmittal Number: IA-09-019
State: Iowa
Summary: These changes implement a temporary reduction (for the remainder of SFY 2010) in the pharmacy dispensing fee from $4.57 to $4.34 and implements a new permanent methodology for the determination of the EAC for specialty drugs at AWP minus 17% as opposed to the non-specialty BAC of AWP minus 12%.
Approval Date:
Effective Date:
Topics:
  • Prescription Drugs
Links:
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Transmittal Number: OR-09-11
State: Oregon
Summary: Requires a Prior Authorization for non-preferred drug use.
Approval Date:
Effective Date:
Topics:
  • Prescription Drugs
  • Program Administration
Links:
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Transmittal Number: WA-09-018
State: Washington
Summary: Decreases Pharmacy Payment for Estimated Acquisition Costs from AWP 14% to AWP - 16%.
Approval Date:
Effective Date:
Topics:
  • Prescription Drugs
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT