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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 include the new adult group in Community Care of North Carolina (CCNC) primary care case management entity (PCCMe) program eligibility.
Summary: This amendment is to include the new adult group in Eastern Band of Cherokee Indians (EBCI) Tribal Option primary care case management entity (PCCMe) program eligibility.
Summary: This amendment is to define the Alternative Benefit Plan (ABP) that will be used to implement certain requirements for the new North Carolina Medicaid Expansion eligibility group as required by SL 2023-7. The Act allows for the inclusion of Medicaid eligibility to individuals aged 19‐64 with incomes at or below 133 percent of the federal poverty level who are not enrolled in or eligible for Medicare, consistent with the new adult group eligibility criteria as defined by the Affordable Care Act.
Summary: Added coverage for the eligibility group serving individuals under age 65 with incomes at or below 133% of the FPL under Section 1902(a)(10)(A)(viii) of the Social Security Act.
Summary: This SPA describes the methodology used by the state for determining the appropriate FMAP rates, including the increased FMAP rates, available under the provisions of the Affordable Care Act applicable for the medical assistance expenditures under the Medicaid program associated with enrollees in the new adult group adopted by the state and described in 42 CFR 435.119.
Summary: Transitions Illinois children enrolled through the sperate CHIP Program to Medicaid expansion coverage through the Optional Targeted Low Income Children eligibility group.
Summary: This amendment proposes to change provider requirements for community mental health centers, adds coverage of prophylaxis under the state’s dental benefit, allows for 90-day coverage of maintenance medications, and adds weight loss drugs to the state’s prescription drug formulary.
Summary: Added coverage for the eligibility group for adults with income below 133% of the FPL under Section 1902(a)(10)(A)(viii) of the Social Security Act:
Summary: This amendment proposes to implement temporary policies, which are different from those policies and procedures otherwise applied under your Medicaid state plan, during the period of the Presidential and Secretarial emergency declarations related to the COVID- 19 outbreak (or any renewals thereof).
