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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 is to provide children under age 19 with 12 months of continuous eligibility in Medicaid, in accordance with Section 1902(e)(12) of the Social Security Act, as amended by Section 5112 of the Consolidated Appropriations Act, 2023. Children under age 19 will remain continuously eligible for the full 12-month certification period, regardless of changes in circumstances with certain exceptions.
Summary: This amendment is to update the state's minimum personal needs allowance for individuals residing in a nursing facility (NF), assisted living facility, intermediate care facilities for individuals with intellectual disabilities (ICFs/IID), or other similar long-term care facility from $60 to $75 for individuals and from $120 to $150 for couples.
Summary: This amendment is to adopt the changes to 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: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to allow the territory to consider individuals absent from the territory to continue to be residents; to provide rate increases for FQHC medical encounters rendered at government quarantine locations; to create payment methodology for local non-government dialysis centers in AS during the PHE period; to revise the payment methodology for off-island dialysis; and to revise payment methodology for transportation and related accommodations associated with return from off-island medical care.
Summary: This amendment expands the needs based-eligibility criteria for the Home and Community-Based Services - Adult Mental Health (HCBS-AMH) 1915(i) programs to include adults with a diagnosis of a serious mental illness (SMI) who have a history of psychiatric crisis and repeated discharges from correctional facilities, as well as adults with a diagnosis of SMI who have a pattern of emergencydepartmentutilization.
Summary: Establishes that the Texas Health and Human Services Commission (HHSC) will determine financial eligibility for most Medicaid programs using the new federal income rules.
Summary: This state plan amendment establishes that the State is using federally required modified adjusted gross income (MAGI) methodology for determining Medicaid eligibility criteria for children, parents and caretakers, pregnant women, and individuals under age 21 who were formerly under Texas conservatorship.
