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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 align the Alternative Benefit Plan with the Medicaid state plan by adding Supported Employment as a covered service.
Summary: This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by allowing physician assistants, nurse practitioners, and clinical nurse specialists, in addition to physicians, to order home health services, including durable medical equipment and medical supplies.
Summary: This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by adding Medication Therapy Management (MTM) under Pharmacist Services.
Summary: This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by adding pharmacies as supervisors for Community Health Workers. This SPA also updates the ABP to add peer support services, Drug Medi-Cal Organized Delivery Systems SUD treatment, and mobile crisis teams.
Summary: This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by allowing FQHCs and RHCs to bill for encounters by licensed professional clinical counselors and associate professional clinical counselors.
Summary: This amendment is to align the Alternative Benefit Plan with the Medicaid state plan by adding doula services and updates the Federally Qualified Health Centers (FQHC) and Rural Health Clinic (RHC) services category to include associate marriage and family therapist (AMFT) services and associate clinical social worker (ACSW) services.
Summary: This amendment proposes to align the Alternative Benefit Plan with the Medicaid state plan by adding asthma prevention services, community health worker services, and coverage of routine patient costs in clinical trials.
Summary: This amendment aligns the Alternative Benefit Plan (ABP) with the Medicaid state plan by adding specified pharmacist services as a Medi-Cal benefit.
Summary: This amendment aligns the Alternative Benefit Plan (ABP) with the Medicaid state plan by adding coverage for audiology/speech therapy, podiatry, optometric and optician services, and incontinence creams and washes. This SPA also removes the two-visit limit for podiatrist services.
Summary: This amendment aligns the Alternative Benefit Plan (ABP) with the Medicaid state plan by adding Diabetes Prevention Program (DPP) services for adults ages 18 years and older who meet certain federal Centers for Disease Control and Prevention (CDC) Diabetes Prevention Recognition Program (DPRP) eligibility criteria.
