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Medicaid State Plan Amendments

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.

Results

Displaying 1 - 10 of 15764

Rhode Island

This amendment proposes that Rhode Island update its Medicaid State Plan to attest compliance with the new “four walls” exception for Indian Health Services (IHS) and Tribal Facilities.

Approval Date: June 9, 2025
Effective Date: January 1, 2025
Topics: Clinic Coverage Indian Health Services Program Administration Tribal Issues

Wisconsin

This Amendment resource disregard of cash received in conjunction with governmental or nongovernmental medical or social services programs.

Approval Date: June 9, 2025
Effective Date: January 1, 2025
Topics: Eligibility Medicaid and CHIP Program (MACPro)

Michigan

This plan amendment updates the Current Procedural Terminology (CPT) codes applicable to the Primary Care Practitioner (PCP) Services.

Approval Date: June 9, 2025
Effective Date: January 1, 2025

Vermont

This amendment proposes to update limits and prior authorization requirements for physical, occupational and speech/language therapy services to reduce the burden to access these services.

Approval Date: June 6, 2025
Effective Date: January 1, 2025
Topics: Coverage Prior Authorization Program Administration

Montana

This amendment requests an extension of the exception to the Recovery Audit Contractor (RAC) requirements for an additional two (2) years, through April 30, 2027.

Approval Date: June 6, 2025
Effective Date: April 1, 2025
Topics: Program Administration

Louisiana

This State Plan Amendment requests an extension of the exemption from participation in the Recovery Audit Contractor (RAC) program.

Approval Date: June 4, 2025
Effective Date: August 6, 2025
Topics: Program Administration

New Hampshire

This plan updates the rates and clarifies methodology language for laboratory services, radiology services, and durable medical equipment (DME).

Approval Date: June 4, 2025
Effective Date: January 1, 2025

Connecticut

This plan amendment updates the Community First Choice (CFC) program to comply with the Collective Bargaining Agreement (CBA).

Approval Date: June 4, 2025
Effective Date: January 1, 2025

North Carolina

This plan amendment revises hospital readmission review requirements from 30 days to 72 hours to align with Clinical Policy.

Approval Date: June 4, 2025
Effective Date: January 1, 2025

Michigan

This plan amendment aligns the Non-Emergency Transportation (NEMT) mileage rate with the Internal Revenue Service (IRS) Standard Business rate.

Approval Date: June 4, 2025
Effective Date: May 1, 2025