Medicaid State Plan

• 1.1 Designation of Authority
  • Attachment A - Attorney General's Clarification
• 1.2 Organization for Administration
  • Attachment A - Organization and Function of State Agency
  • Attachment B - Organization and Function of Medical Assistance Unit
  • Attachment C - Professional Medical and Supporting Staff
• 1.3 Statewide Operations
• 1.4 State Medical Care Advisory Committee
• 1.5 Pediatric Immunization Program

2.1 Application, Determination of Eligibility and Furnishing Medicaid

2.2 Coverage and Conditions of Eligibility

• Attachment A: Groups Covered and Agencies Responsible for Eligibility
  • Supplement 1 - Reasonable Classifications
  • Supplement 2 -More Restrictive Eligibility
  • Supplement 3 -Cost Effectiveness Determination for Children at Home
  • Supplement 8- More Liberal Treatment of Income

2.3 Residence

2.4 Blindness

2.5 Disability

2.6 Financial Eligibility

• Attachment A: Eligibility Conditions and Requirements
  • Supplement 1 - Income Eligibility Levels
  • Supplement 2 - Resource Level
  • Supplement 3- Reasonable Limits on Amounts
  • Supplement 4 - Treatment of Income
  • Supplement 5 - More Restrictive Methods
  • Supplement 5a - Treatment of Resources
  • Supplement 6 - Standards for Optional Payment
  • Supplement 7 - Income for Categorically Needy
  • Supplement 8 - Resources for Categorically Needy
  • Supplement 8a - Income Treatment, More Liberal Methods
  • Supplement 8a - Less Restrictive Methods of Treating Income
  • Supplement 8b - Methods of Treating Resources
  • Supplement 8c - Long Term Care Partnership
  • Supplement 9 - Transfer of Resources
  • Supplement 9b - Transfer of Assets
  • Supplement 10 - Medicaid Qualifying Trust
  • Supplement 11 - Cost Effectiveness for COBRA
  • Supplement 12 - Personal Needs Allowances
  • Supplement 12a - Section 1931
  • Supplement 12a - Section 1931- Addendum
  • Supplement 13 - Section 1924 Provisions
  • Supplement 14 - Income and Resources for TB Infected
  • Supplement 16 - Asset Verification System
  • Supplement 17 - Home Equity Disqualifications for Long Term Care
  • Supplement 18 - Adult Group Methodology
• Attachment B: Financial Eligibility Requirements for Non-Magi Groups
• Attachment C: Methods of Treating Income and Resources

2.7 Medicaid Furnished Out of State

3.1 Amount, Duration, and Scope of Services

• Attachment A - Medical & Remedial Services for Categorically Needy
  • Supplement 1 - Medical & Remedial Services Limits
  • Supplement 1a - Targeted Case Management
• Attachment A.1 - Requirements for Outpatient Drugs
• Attachment C - Assurance of Quality Services
• Attachment D - Transportation Assurance
• Attachment E - Organ Transplants
• Attachment F - Primary Care Case Management (PCCM)
• Attachment G - Reserved
• Attachment H - Health Homes
• Attachment L - Institutions for Mental Diseases
• Attachment M - Eligible Juvenile Inmates of a Public Institution

3.2 Medicaid, Medicare and Other Insurance

• Attachment A - Medicare Parts A & B Benefits

3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases

3.4 Special Requirements Applicable to Sterilization Procedures

3.5 Families Receiving Extended Medicaid Benefits

• 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
• 4.12 Consultation to Medical Facilities
• 4.13 Required Provider Agreement
• 4.14 Utilization Control
• 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
• 4.17 Liens and Recoveries
  • Attachment A -Liens and Adjustments
• 4.18 Cost Sharing and Similar Charges
  • Attachment A - Charges on Categorically Needy
  • Attachment D - Premiums on LI Pregnant Women
  • Attachment E - Sliding Scale Premium
• 4.19 Payment for Services
  • Attachment A - Inpatient Hospital Payment Methodology
  • Attachment B - Payment Methods for Physician & Other Services
    • Supplement 1 - Payment of Medicare Part A and Part B Deductible/Coinsurance
  • Attachment C - Payments for Reserved Bed Days
  • Attachment D - Payment Methodologies for Nursing Facilities and Intermediate Care Facilities
  • Attachment E - Definition of a Claim

• 4.20 Direct Payments to Certain Recipients for Physicians' or Dentists' Services
• 4.21 Prohibition Against Reassignment of Provider Claims
• 4.22 Third Party Liability
  • Attachment A - Payment of Claims
  • Attachment C - Cost Effectiveness Methodology
• 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 and Other Individuals
  • Attachment A - Sanctions for Psychiatric Hospitals
• 4.31 Disclosure of Information by Providers and Fiscal Agents
• 4.32 Income and Eligibility Verification System
  • Attachment A - Requests to Other State Agencies
• 4.33 Medicaid Eligibility Cards for Homeless Individuals
  • Attachment A - Method for Issuance
• 4.34 Systematic Alien Verification for Entitlements
  • Attachment A - Advance Directives Requirement
• 4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that do not Meet Requirements of Participation
  • Attachment A - Eligibility Requirements
  • Attachment B - Termination of Provider Agreement
  • Attachment C - Temporary Management
  • Attachment D - Payment Denial - New Admissions
  • Attachment E - Civil Monetary Penalty
  • Attachment F - State Monitoring
  • Attachment G - Transfer of Residents
  • Attachment H - Additional Remedies
• 4.36 Required Coordination between the Medicaid and WIC Programs
• 4.38 Nurse Aid Training and Competency Evaluation for Nursing Facilities
  • Attachment A - Collection of Additional Registry Info
  • Attachment B - Disclosure of Additional Registry Info
• 4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities
  • Attachment A - Categorical Determinations
  • Attachment B - Definition of Specialized Services
• 4.40 Survey and Certification Process
  • Attachment A - Survey and Certification and Education Program
  • Attachment B - Eligibility Requirements
  • Attachment C - Scheduling and Conduct of Surveys
  • Attachment D - Programs to Measure and Reduce Inconsistency
  • Attachment E - Investigations and Requirements
• 4.41 Resident Assessment for Nursing Facilities
• 4.42 False Claim Recoveries
  • Attachment A - False Claims Recoveries Education
• 4.43 Medicaid Integrity Program Efforts
• 4.44 Payments to Providers Outside the United States
• 4.46 Provider Screening and Enrollment

• 5.1 Standards of Personnel Administration
• 5.2 RESERVED
• 5.3 Training Programs; Subprofessional and Volunteer Programs

• 1.1 Designation of Authority
• 6.1 Fiscal Policies and Accountability
• 6.2 Cost Allocation
• 6.3 State Financial Participation

• 7.1 Plan Amendments
• 7.2 Nondiscrimination
  • Nondiscrimination in Federal Assistance Programs
• 7.4 State Governor's Review
• 7.5 Medicaid Disaster Relief for COVID-19 National Emergency
• 7.7 COVID-19 Vaccine, Testing and Treatment
  • Attachment A COVID-19 Vaccine and Vaccine Administration
  • Attachment 7.7-B COVID-19 Testing
  • Attachment 7.7-C COVID-19 Treatment

• A1 - A3 Medicaid Administration

  • A1 Designation and Authority
  • A2 Organization and Administration
  • A3 Assurances

• Mandatory Eligibility Groups - MAGI and Non-MAGI
• S10 MAGI-Based Income Methodologies
• S14 AFDC Income Standards
• Presumptive Eligibility by Hospitals
• S25 Eligibility Groups: Mandatory Parents and Other Caretaker Relatives
• S30 Eligibility Groups: Mandatory Infants and Children Under Age 19
• S32 Eligibility Groups: Mandatory Adult Group
• S33 Eligibility Groups: Mandatory Former Foster Care Children
• S50 Eligibility Groups: Optional Individuals Over 133%
• S51 Eligibility Groups: Optional Parents and Other Caretaker Relatives
• S52 Eligibility Groups: Optional Reasonable Classification of Individuals
• S53 Eligibility Groups: Optional Children with Non IV-E Adoption Assistance
• S54 Eligibility Groups: Optional Targeted Low Income Children
• S55 Eligibility Groups: Optional Individuals with Tuberculosis
• S57 Eligibility Groups: Optional Independent Foster Care Adolescents
• S59 Eligibility Groups: Optional Individuals Eligible for Family Planning Services
• S88 Non-Financial Eligibility: State Residency
• S89 Non-Financial Eligibility: Citizenship and Non-Citizen Eligibility
• S94 General Eligibility Requirements: Eligibility Process
  

• ABP1 Alternative Benefit Plan Populations
• ABP2a Voluntary Benefit Package Selection Assurances
• ABP3.1 Selection of Benchmark Benefit Package or Benchmark-Equivalent Benefit Package
• ABP4 Alternative Benefit Plan Cost-Sharing
• ABP5 Benefits Description
• ABP7 Benefits Assurances
• ABP8 Service Delivery Systems
• ABP9 Employer Sponsored Insurance and Payment of Premiums
• ABP10 General Assurances
• ABP11 Payment Methodology