An official website of the United States government
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.
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 adds coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage, as well as describe the reimbursement for prescribed drugs that are not covered outpatient drugs.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow cover the new optional group for COVID testing; apply less strict resource and income methods when determining eligibility for certain individuals; consider individuals evacuated from the state due to the emergency to continue to be residents; provide medical coverage to non-residents who are quarantined in the state due to COVID-19; allow hospitals to make presumptive eligibility decisions for certain individuals; suspend enrollment fees and premiums for all individuals; expand telehealth; add certain benefits and increase some payment rates related to the COVID-19 national emergency.
Summary: Affirms state compliance with sections 1902(a)(85), 1902(a)(83)(oo), and 1927(g) of the Social Security Act; updates Drug Utilization Review program information; affirms state fraud and abuse processes related to opioids; affirms MCO requirements to participate in SUPPORT Act-mandated actions; and updates language to align with language in the Social Security Act and CFR
Summary: Removes the detailed lists of specific covered drugs or classes of drugs and replacing the lists with references, including links, to other sources containing the information.
Summary: Proposes to allow the state to directly negotiate supplemental Value Based Purchasing (VBP) agreements with drug manufacturers. This SPA will be used by the state in particular to address the hepatitis C (HCV) virus patient population by allowing it to contract with a manufacturer(s) under a subscription model, allowing the state to purchase an unlimited amount of HCV direct-acting antivirals as needed for a fixed fee and time period. Once approved, this SPA will be the 4th Value Based Purchasing Supplemental Rebate Agreement that CMS has authorized.
Summary: The SPA implements a single Medicaid Apple Health Preferred Drug List (PDL), to be used by Washington's contracted Medicaid managed care organizations (MCOs) and the fee-for-service (FFS).
Summary: This SPA amends the limitations on prescription drug coverage to clarify that agents when used for cosmetic purposes or hair growth will only be covered when the state has determined that use to be medically necessary.
Summary: To transition another county from voluntary enrollment to mandatory enrollment, to add new populations to voluntary managed care and to make technical corrections.
Summary: Limits the reach of Washington's estate recovery program to only nursing facility services, home and community based services and related hospital & prescription drugs services, for those 55 and over.
