Medicaid State Plan

Section 1.0 – Single State Agency Organization

• MAGI A1-A3  
• Superseding Template for A1-A3
• Organization, Designation, and Authority
• 1.4 – Tribal Consultation
• 1.5 – Pediatric Immunization Program

Section 2.0 – Coverage and Eligibility

• MAGI Medicaid Eligibility
• Superseding Template
• MAGI (S-10) Methodology
• Superseding Template for S-10
• MAGI (S-21) Hospital Presumptive Eligibility
• MAGI (S-32) New Adult Group (Expansion Population)
• MAGI (S-88) State Residency
• Superseding Template for S-88
• MAGI (S-89) Citizenship and Non-Citizen Eligibility
• Superseding Template for S-89
• MAGI (S-94) Medicaid Eligibility Process
• Continuous Eligibility for Pregnant Women and Extended Postpartum Coverage
• 2.1 – Application, Determinations of Eligibility, and Furnishing Medicaid
• 2.2 – Coverage and Conditions of Eligibility
• Attachment A – Groups Covered and Agencies Responsible for Eligibility
• Supplement 3 – Methods for Determining Cost-Effectiveness of Caring for Certain Disabled Children at Home
• 2.4 – Blindness
• 2.5 – Disability
• 2.6 – Financial Eligibility
• Attachment A – Eligibility Conditions and Requirements
• Supplement 1 – Income Eligibility Levels
• Supplement 2 – Categorically Needy Groups
• Supplement 3 – Reasonable Limits
• Supplement 4 – Treatment of Income Methods (different from SSI)
• Supplement 5 –Treatment of Resources
• Supplement 6 – Standards for Optional State Supplementary Payments
• Supplement 7 – Income Levels for 1904(f) States
• Supplement 8 – Resource Standards for 1904(f) States
• Supplement 8a – More Liberal Methods of Treating Income under Section 1902(r)(2) of the Act [section 1902(f) state)
• Supplement 8b - More Liberal Methods of Treating Income under 1902(r) of the SSA [non-section 1902(f) state]
• Supplement 9 – Transfer of Resources (Institutional)
• Supplement 9a – Transfer of Assets
• Supplement 9b – Transfer of Assets – less than market value
• Supplement 10 – Trust & Hardship Provisions
• Supplement 11 – Cost-Effectiveness Methodology for COBRA
• Supplement 12 – Personal Needs Allowance & Transitional Medical Assistance
• Supplement 13 – Section 1924 Provisions
• Supplement 16 – Asset Verification System
• Supplement 17 – Disqualification for LTC Assistance (Substantial Home Equity)
• Supplement 18 – Methodology for Identifying FMAP Rates
• 2.7 – Medicaid Furnished Out of State
• Attachment A – Medicaid Furnished in Canada

Section 3.0 – Services: General Provisions

• 3.1 – Amount, Duration, and Scope of Services
• Attachment A – Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy Groups
• Attached Sheets – Benefits
• Supplement 1 – Targeted Case Management
• Supplement 2 – Medication-Assisted Treatment (October 1, 2020 – September 30, 2025)
• Attachment B - Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Medically Needy Groups
• Attachment C – Standards and Methods of Assuring High-Quality Care
• Attachment D – Methods of Assuring Transportation
• Attachment E – Standards for the Coverage of Organ Transplant Services
• Attachment K – Community First Choice
• Attachment L – Alternative Benefit Plan (Expansion Group)
• 3.2 – Coordination of Medicaid with Medicare Part B
• Attachment A - Coordination of Title XIX with Part B of Title XVIII
  
• 3.3 – Medicaid for Individuals Aged 65 and Over in Institutions for Mental Diseases
• 3.4 – Special Requirements Applicable to Sterilization Procedures
• 3.5 – Medicaid for Medicare Cost-Sharing for Qualified Medicare Beneficiaries

Section 4.0 – Program Administration and Reimbursement

• 4.1 – Methods of Administration
• 4.2 – Hearings for Applicants and Recipients
• 4.3 – Safeguarding Information on Applicants and Recipients
• 4.4 – Medicaid Quality Control
• 4.5 – Medicaid Agency Fraud Detection and Investigation Program
• 4.6 – Reports
• 4.7 – Maintenance of Records
• 4.8 – Availability of Agency Program Manuals
• 4.9 – Reporting Provider Payments to the Internal Revenue Service
• 4.10 – Free Choice of Providers
• 4.11 – Relations with Standard Setting and Survey Agencies (
• Attachment A – Standards for Institutions
• 4.12 – Consultation with Medical Facilities
• 4.13 – Required Provider Agreement
• 4.14 – Utilization Control
• Attachment B – Utilization Control Procedures
• 4.15 – Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases
• 4.16 – Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
• Attachment A – Cooperative Agreements with State Health and State Vocational Rehabilitation Agencies and with Title V Grantees
• Supplement 1 – Memorandum of Agreement
• Supplement 2 – Cooperative Agreement
• 4.17 – Liens and Recoveries
• Attachment A – Liens and Adjustments or Recoveries
• 4.18 – Cost Sharing and Similar Charges
• Attachment A – Recipient Cost Sharing
• Attachment C – Charges Imposed on Categorically Needy and Other Optional Groups
• Attachment D – Premiums Imposed on Low-Income Pregnant Women and Infants
• Attachment E – Premiums Imposed on Qualified Disabled and Working Individuals
• 4.19 – Payment for Services
• Attachment A – Methods and Standards for Establishing Payment Rates – Inpatient Hospital Care
• Attachment B – Methods and Standards for Establishing Payment Rates – Other Types of Care
• ­Supplement 1 – Payment of Medicare Part A and Part B Deductible/Coinsurance
• Attachment C – Payments for Reserved Beds & Tribal Health System Reimbursement
• Attachment D – Methods and Standards for Establishing Payment Rates – Skilled Nursing and Intermediate Care Facility Services
• Attachment A to Attachment D – Supporting Statutes
• Attachment E – Timely Claims Payment – Definition of a Claim
• Attachment F – Federal Matching of Y2K-Related State Projected Payments to Medicaid and State Children’s Health Insurance Program Providers.
• 4.20 – Direct Payments to Certain Recipients for Physician or Dentist Services
• 4.21 – Prohibition Against Reassignment of Provider Claims
• 4.22 – Third-Party Liability
• Attachment A – Requirements for Third-Party Liability – Identifying Liable Resources
• Supplement 1 – State Laws Requiring Third Parties to Provider Coverage Eligibility and Claims Data
• Attachment B – Requirements for Third-Party Liability – Payment of Claims
• Attachment C – Condition or Requirement; Enrollment of Individuals under Group Health Plans
• 4.23 – Use of Contracts
• 4.24 – Standards for Payments for Skilled Nursing and Intermediate Care Facility Services
• 4.25 – Program for Licensing Administrators of Nursing Homes
• 4.26 – Drug Utilization Review Program
• 4.27 – Disclosure of Survey Information and Provider or Contractor Evaluation
• 4.28 – Appeals Process
• 4.29 – Conflict of Interest Provisions
• 4.30 – Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals
• 4.31 – Disclosure of Information by Providers and Fiscal Agents
• 4.33 – Medicaid Eligibility Cards for Homeless Individuals
• Attachment A – Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
• 4.34 – Systematic Alien Verification for Entitlements
• Attachment A – Requirements for Advance Directives Under State Plans for Medical Assistance
• 4.35 – Remedies for Skilled Nursing and Intermediate Care Facilities that do not Meet Requirements of Participation
• Attachment A – Eligibility Conditions and Requirements; Enforcement of Compliance for Nursing Facilities
• Attachment B – Eligibility Conditions and Requirements; Enforcement of Compliance for Nursing Facilities: Termination of Provider Agreement
• Attachment C – Eligibility Conditions and Requirements; Enforcement of Compliance for Nursing Facilities: Temporary Management
• Attachment D – Eligibility Conditions and Requirements; Enforcement of Compliance for Nursing Facilities:  Denial of Payment for New Admissions
• Attachment E – Eligibility Conditions and Requirements; Enforcement of Compliance for Nursing Facilities: Civil Monetary Penalty
• Attachment F – Eligibility Conditions and Requirements; Enforcement of Compliance for Nursing Facilities: State Monitoring
• Attachment G – Eligibility Conditions and Requirements; Enforcement of Compliance for Nursing Facilities: Transfer of Residents (
• Attachment H – Eligibility Conditions and Requirements; Enforcement of Compliance for Nursing Facilities: Additional Remedies
• 4.36 – Required Coordination between Medicaid and WIC Programs
• 4.37 – Prescribed Drugs; Manufacturer Rebates
• 4.38 – Nurse Aide Training and Competency Evaluation for Nursing Facilities
• 4.39 – Preadmission Screening and Annual Resident Review in Nursing Facilities (PASARR)
• Attachment A – Categorical Determinations
• 4.42 – Employee Education about False Claims Recoveries
• Attachment A – Methodology of Compliance Oversight
• 4.43 – Medicaid Integrity Program
• 4.44 – Medicaid Prohibition on Payments to Institutions or Entities located Outside of the United States
• 4.46 – Provider Screening and Enrollment

Section 5.0 – Personnel Administration

• 5.1 – Standards of Personnel Administration
• 5.2 – Reserved
• 5.3 – Training Programs: Subprofessional and Volunteer Programs

Section 6.0 – Financial Administration

• 6.1 – Fiscal Policies and Accountability
• 6.2 – Cost Allocation
• 6.3 – State Financial Participation

Section 7.0 – General and Time-Limited Provisions

• 7.1 – Plan Amendments
• 7.2 – Nondiscrimination
• 7.4 – Public Health Emergency Amendments 
• Attachment A – Rescission of Extension of dSPA Authority; HCBS Reimbursement
  
• Attachment B – Extension of dSPA Authority; HCBS Reimbursement & Pharmacy Dispensing Fees
• Attachment C - Extension of 1135 and dSPA authority; Medicaid fee-for-service prior/service authorization requirements for behavioral health services & pharmacy dispensing fees
  

• Attachment A – ARPA Coverage Period Vaccine Product and Vaccine Administration
• Attachment B – ARPA Coverage Period COVID-19 Testing
• Attachment C – ARPA Coverage Period COVID-19 Treatment