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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 will allow Medicaid to exempt the following drugs from Medicaid co-payments: Opioid Antagonists, Nicotine Replacement Therapy, and medications used to treat opioid use disorder.
Summary: This amendment will allow Medicaid to exempt anti-retroviral medications used to treat HIV for the purpose of reducing viral load from Medicaid co-payments. These medications currently require a co-payment of $4 per prescription.
Summary: Allows health plans to require cost sharing for certain beneficiaries under managed care. This carries over a policy for the same group under the state's fee-for-service programs, and as such will not increase costs or utilization.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to eliminate all cost sharing for testing and treatment that may be COVID-19 related, suspend enrollment fees and monthly premiums for the Health Care for Workers with Disabilities (HCWD) program; allow increased payment rates of 5% to certain FFS programs; add a 5% additional rate increase to support specific providers who may be experiencing a disproportionate impact; set payment rates for telehealth; and add an interim payment methodology.
Summary: Including references to the federally recognized tribes (Eastern Band of Cherokee Indians), where appropriate, to ensure all duties, roles and responsibilities previously assigned to county divisions of social services are shared with the tribe for individuals living within the tribal boundary.
