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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: Technical change to align with New York statute, which allows residents of Adult Care Facilities to receive both Hospice and Assisted Living Program services without having to disenroll from either, was originally approved on February 26, 2025.
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 amendment proposes to cover the Chronic Disease Self-Management Program (CDSMP) for Arthritis for dates of service on or after October 1, 2023.
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extends ARPA Initiative regarding PDN_C19 Test and Specimen Collection.
Summary: This SPA proposes to modify language on the excluded drug coverage pages to reflect coverage of selective medications by referencing the state’s webpage resources instead of listing specific covered medications.
Summary: To add coverage to Medicaid for preventive health services provided by certified dietitians and nutritionists, and Community Health Workers (CHWs) to pregnant and post-partum women.
Summary: This amendment proposes to change the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Pub. L. No. 115-217, section 1002.
Summary: to decrease the administrative burden on enrolled fee-for-service Medicaid members and providers but will continue to meet the federal regulatory requirements at 42 CFR Part 456, Subparts A and B. This will be accomplished through continued utilization monitoring in a postpayment review process, with referral to the Office of Health Insurance Program (OHIP) prepayment Provider on Review Program, and to the Office of the Medicaid Inspector General (OMIG) where suspected fraud, waste or abuse are identified in the unnecessary or
inappropriate use of care, services or supplies by members or providers.
