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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.

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Showing 1 to 10 of 282 results
Transmittal Number: NY-24-0074
State: New York
Summary: This SPA updates the reimbursement methodology of covered outpatient and prescribed drugs as well as physician administered drugs.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
  • Prescribed Drugs
  • Covered Outpatient Drug
  • Physician Administered Drugs
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: NJ-24-0023
State: New Jersey
Summary: This SPA allows coverage of select prescribed drugs that do not meet the definition of covered outpatient drugs. Additionally, this SPA also allows reimbursement of prescribed drugs with the same reimbursement methodologies as covered outpatient drugs.
Approval Date:
Effective Date:
Topics:
  • Prescribed Drugs
  • Reimbursement
  • Covered Outpatient Drug
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: UT-24-0021
State: Utah
Summary: This SPA removes specifics for identifying claims for covered outpatient drugs purchased through the 340B Program, as industry standards may periodically change.
Approval Date:
Effective Date:
Topics:
  • 340B Program
  • Covered Outpatient Drug
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: CO-24-0015
State: Colorado
Summary: This SPA adds coverage of select prescribed drugs that are not covered outpatient drugs, and also adds coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage.
Approval Date:
Effective Date:
Topics:
  • Covered Outpatient Drug
  • Prescribed Drugs
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: IL-24-0013
State: Illinois
Summary: This SPA adds coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage.
Approval Date:
Effective Date:
Topics:
  • Covered Outpatient Drug
  • Prescribed Drugs
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: NJ-24-0007
State: New Jersey
Summary: This SPA adds coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage.
Approval Date:
Effective Date:
Topics:
  • Prescribed Drugs
  • Covered Outpatient Drug
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: WA-24-0020
State: Washington
Summary: This SPA adds coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage, as well as describe the reimbursement for prescribed drugs that are not covered outpatient drugs.
Approval Date:
Effective Date:
Topics:
  • Covered Outpatient Drug
  • Prescription Drugs
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: UT-24-0002
State: Utah
Summary: This SPA proposes to clarify the reimbursement for certain provider administered drugs.
Approval Date:
Effective Date:
Topics:
  • Covered Outpatient Drug
  • Physician Administered Drugs
  • Prescribed Drugs
  • Prescription Drugs
  • Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: DC-23-0016
State: District of Columbia
Summary: This amendment allows the District to update the state’s excluded drug listing; to provide coverage for select agents for the treatment of infertility; to enter in Outcome-based arrangements with manufacturers; and to increase flexibility to improve access to prescription and over-the-counter drugs.
Approval Date:
Effective Date:
Topics:
  • Value Based Purchasing
  • Prescribed Drugs
  • Covered Outpatient Drug
  • Over-the-Counter Drugs
  • Non-prescription Drugs
  • Fertility Drugs
  • Excluded Drug Coverage
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: OK-24-0003-B
State: Oklahoma
Summary: This amendment will replace instances of the term "Naloxone" with the broader term "opioid overdose reversal agent" as newer products of the class become available.
Approval Date:
Effective Date:
Topics:
  • Prescribed Drugs
  • Covered Outpatient Drug
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT