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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 ABP updates the coverage limit for diagnostic, preventative, and restorative dental services for adults aged 21 and older, excluding cosmetic services. It also aligns non-EHB adult dental coverage with changes approved in WV-24-0002.
Summary: This amendment proposes to update the coverage limit for dental services for adults aged 21 and older for diagnostic, preventative, and restorative services, excluding cosmetic services.
Summary: This amendment proposes to expand the scope of covered dental services that are available to individuals over age 21. Individuals over age 21 will receive the following medically necessary dental services: diagnostic, preventive, restorative, periodontal, prosthodontic, orthodontic, endodontic, emergency dental services, and oral surgery (inpatient and outpatient).
Summary: This amendment updates provisions for dental services, increases payments for a range of Medicaid-covered services, and incorporates updates to Healthcare Common Procedure Code System (HCPCS) codes effective January 1, 2024.
Summary: This SPA authorizes increased FFP for newly-eligible individuals receiving postpartum coverage and further includes the addition of Attachment D, which describes the special circumstances and other proxy adjustments that are applied to account for the proportion of individuals covered under the extended postpartum coverage option who would otherwise be eligible for coverage in the adult group and for the newly eligible FFP under section 1905(y) of the Social Security Act.
Summary: This amendment proposes to increase the annual dental cap for adults from $1,000 to $1,500 and to allow emergency dental services for adults to be covered after the annual cap on dental expenditures has been met.
Summary: This amendment proposes to remove the optional service, case management of high-risk pregnant women, from the Delaware Medicaid State Plan as these services will now be provided via an evidence-based home visiting model under 1115 waiver authority, effective January 1, 2023.
