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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 proposes to prohibit third-party payers from refusing payment for an item or service solely on the basis that such item or service did not receive prior authorization under the third-party payer’s rules, consistent with the Consolidated Appropriations Act 2022.
Summary: This SPA revises the amount for the personal needs allowance (PNA) provided to certain recipients in nursing facilities. The amendment will allow for COLA increases annually.
Summary: To provide 12 months of continuous eligibility for children under age 19 in Medicaid. This amendment will align state policy and practices with federal requirements under section 5112 of the Consolidated Appropriations Act, 2023.
Summary: To implement 12-months of continuous eligibility for children as required by the 2023 Consolidated Appropriations Act. This SPA also makes a technical change to note that the Virginia Department of Medical Assistance Services processes the eligibility applications of individuals who are returning to the community after a period of incarceration. Additionally, this SPA makes technical corrections to the "Eligibility Determinations and Fair Hearings" and "Organization and Administration" reviewable units approved in VA-23-0007 regarding Virginia's transition to a new State-Based Exchange.
Summary: This amendment proposed to provide Medicaid coverage to lawfully residing individuals under the age of 19 and pregnant women who meet all other eligibility requirements for Medicaid in New Hampshire.
Summary: This amendment is to memorialize the new income standards for its optional state supplement program, the beneficiaries of which are eligible for Medicaid under Hawaii's state plan.
Summary: To provide 12 months of continuous eligibility (CE) for children under the age of 19 to comply with Section 5112 of the Consolidated Appropriations Act, 2023.
