Medicaid State Plan

• Section 1.1 - Designation and Authority
  
  • Attachment 1.1a - Certification of Single State Agency
• Section 1.2 - Organization for Administration
  
  • Attachment 1.2a - State Agency Organization and Functions
  • Attachment 1.2b - Organization and Function of Bureau of Health Services Financing
  • Attachment 1.2c - Professional Medical and Supporting Staff
  • Attachment 1.2d - Description of Staff Making Eligibility Decisions
• Section 1.3 - Statewide Operation
• Section 1.4 - State Medical Care Advisory Committee
• Section 1.5 - Pediatric Immunization Program
• Section 1.6 - Tribal Consultation of SPA Process

• Section 2.1 - Application Determination of Eligibility and Furnishing Medicaid
• Section 2.2 - Coverage and Conditions of Eligibility
  
  • Attachment 2.2a - Groups Covered and Agencies Responsible for Eligibility
    
    • Supplement 1 - Reasonable Classifications of Individuals
• Section 2.3 - Residence
• Section 2.4 - Blindness
• Section 2.5 - Disability
• Section 2.6 - Financial Eligibility
  
  • Attachment 2.6A Eligibility Conditions and Requirements
    
    • Supplement 1 - Eligibility Income Levels
    • Supplement 2 - Eligibility Resource Levels
    • Supplement 3 - Reasonable Limits
    • Supplement 5 - Methodologies for Treatment of Income and Resources that Differ from SSI
    • Supplement 5a - Methodologies for Treatment of Resources for Individuals with Income up to a Percentage of FPL
    • Supplement 6 - Standards for Optional State Supplementary Payments
    • Supplement 7 - Categorically Needy who are Covered under Requirements more Restrictive than SSI
    • Supplement 8a - More Liberal Methods of Treating Income under 1902(r)(2) of the Act
    • Supplement 8b - More Liberal Methods of Treating Resources under 1902(r)(2) of the Act
    • Supplement 8c - State Long-Term Care Insurance Partnership
    • Supplement 9 - Transfer of Resources
    • Supplement 9a - Transfer of Assets
    • Supplement 10 - Consideration of Medicaid Qualifying Trusts - Undue Hardship
    • Supplement 12 - Variations from the Basic Personal Needs Allowance
    • Supplement 13 - Section 1924 Provisions
    • Supplement 14 - Income and Resource Requirements for Tuberculosis Infected Individuals
    • Supplement 15 - Treatment of Optional Groups of Qualified Aliens
    • Supplement 16 - Eligibility under Section 1931 of the Act
    • Supplement 17 - Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity
    • Supplement 18 – Federal Medical Assistance Percentage (FMAP)
• Section 2.7 - Medicaid Furnished Out of State
• Section 2.8 - Modified Adjusted Gross Income (MAGI)

• MACPro - General Eligibility Requirements - Application
• MACPro - Eligibility and Enrollment Processes
  • Continuous Eligibility for Children
  • Continuous Eligibility for Pregnant Women and Extended Postpartum Coverage
• MACPro – Eligibility Groups – Mandatory Coverage
  • Former Foster Care Children
  • Qualified Medicare Beneficiaries
  • Qualified Disabled and Working Individuals
  • Specified Low Income Medicare Beneficiaries
  • Qualifying Individuals
• MACPro – Eligibility Groups – Optional Coverage
  • Children under Age 19 with a Disability
  • Age and Disability-Related Poverty Level
  • Individuals Eligible for Cash Except for Institutionalization
  • Individuals in Institutions Eligible under a Special Income Level
  • Medically Needy Population Based on Age, Blindness or Disability
  • Medically Needy
  • Optional Eligibility Groups
  • PACE Participants
  • Ticket to Work Basic
• MACPro - General Administration 
  • Reporting - Child and Adult Core Sets
• MMDL SPAs
  • A1 - A3 Medicaid Administration
  • S10 - MAGI-Based Income Methodologies
  • S14 - AFDC Income Standards
  • S21 - Presumptive Eligibility by Hospitals
  • S25 - Mandatory Coverage - Parents and Other Caretaker Relatives
  • S28 - Mandatory Coverage - Pregnant Women
  • S30 - Mandatory Coverage - Infants and Children Under Age 19
  • S32 - Mandatory Coverage - Adult Group
  • S50 - Options for Coverage - Individuals above 133 FPL
  • S51 - Options for Coverage - Optional Coverage of Parents and Other Caretaker Relatives
  • S52 - Options for Coverage - Reasonable Classification of individuals Under Age 21
  • S53 - Options for Coverage - Children with Non IV-E Adoption Assistance
  • S54 - Options for Coverage - Optional Targeted Low Income Children
  • S55 - Options for Coverage - Individuals with Tuberculosis
  • S57 - Options for Coverage - Independent Foster Care Adolescents
  • S59 - Options for Coverage - 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

• Section 3.1 - Amount, Duration and Scope of Services
  
  • Attachment 3.1a  - Amount Duration and Scope of Services for Categorically Needy
    
    • Item 1 - Inpatient Hospital Services
    • Item 2a - Outpatient Hospital Services
    • Item 2b - Rural Health Clinic Services
    • Item 2c - FQHC Services
    • Item 3 - Other Laboratory and X-Ray Services
    • Item 4a - Skilled Nursing and Surgical Services for Individuals 21 or Older
    • Item 4b - EPSDT Services
    • Item 4c - Family Planning
    • Item 5 - Physician Services
    • Item 5b - Medical and Surgical Services Furnished by a Dentist
    • Item 6 - Medical and Remedial Care Furnished by Other Licensed Practitioners
    • Item 7 - Home Health Care Services
    • Item 9 - Clinic Services
    • Item 12a - Prescribed Drugs
    • Item 12b - Dentures
    • Item 12c - Prosthetic Devices
    • Item 13c - Preventive Services
    • Item 13d - Rehabilitative Services
    • Item 14a - Services for Individuals 65 or older in Institutions for Mental Diseases
    • Item 15 - Intermediate Care Facility Services
    • Item 16 - Inpatient Psychiatric Facility Services for Under 21
    • Item 17 - Nurse Midwife Services
    • Item 18 - Hospice Care Services
    • Item 19 - Targeted Case Management Services
    • Item 19b - Special Tuberculosis-Related Services for Tuberculosis Infected Individuals
    • Item 20a - Pregnancy Related and Postpartum Services
    • Item 20b - Extended Services for Pregnant Women
    • Item 23 - Nurse Practitioner Services
    • Item 24a - Medical Transportation Services
    • Item 24d - Skilled Nursing Facility Services for Individuals Under 21
    • Item 26 - Personal Care Services
    • Supplement 1 - Targeted Case Management
    • Supplement 2 - Self-Directed Personal Assistance Services
    • Supplement 3 - PACE
    • Supplement 4 - Medication-Assisted Treatment
  • Attachment 3.1b - Amount, Duration and Scope of services Provided to Medically Needy Groups
  • Attachment 3.1c - Standards and Methods for Assuring High Quality Care
  • Attachment 3.1d - Methods of Providing Transportation
  • Attachment 3.1e - Standards for Coverage of Organ Transplants
  • Attachment 3.1f - Managed Care

• Section 3.2 - Coordination of Medicaid with Medicare and Other Insurance

  • Attachment 3.2a - Coordination of Medicare
• Section 3.3 - Medicaid for Individuals 65 or Over in Institutions for Mental Disease
• Section 3.4 - Special Requirements Applicable to Sterilization Procedures
• Section 3.5 - Families Receiving Extended Medicaid Benefits
• Section 3.6 - Additional Amounts for Nursing Facility Residents

Alternative Benefit Plan (ABP)

• ABP1 - Alternative Benefit Plan Populations
• ABP2a - Voluntary Benefit Package Selection Assurances - Eligibility Group Under 1902
• ABP3 - 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
• ABP11 - Payment Methodology

• Section 4.1 - Methods of Administration
• Section 4.2 - Hearings for Applicants and Recipients
  
  • Attachment 4.2a - Fair Hearings
• Section 4.3 - Safeguarding Information on Applicants and Recipients
• Section 4.4 - Medicaid Quality Control
• Section 4.5 - Medicaid Agency Fraud Detection and Investigation Program
• Section 4.6 - Reports
• Section 4.7 - Maintenance of Records
• Section 4.8 - Availability of Agency Program Manuals
• Section 4.9 - Reporting Provider Payments to the IRS
• Section 4.10 - Free Choice of Providers
• Section 4.11 - Relations with Standard-Setting and Survey Agencies
  
  • Attachment 4.11a - Standards for Institutions
• Section 4.12 - Consultation to Medical Facilities
• Section 4.13 - Required Provider Agreement
• Section 4.14 - Utilization Control
  
  • Attachment 4.14b - Utilization Review Methods for Intermediate Care Facilities
• Section 4.15 - Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Disease
• Section 4.16 - Relations with State Health and Vocational Rehab Agencies and Title V Grantees
  
  • Attachment 4.16a - Interrelations with State Health and Vocational Rehab Agencies and Title V Grantees
• Section 4.17 - Liens and Adjustments or Recoveries
  
  • Attachment 4.17a - Liens and Adjustments or Recoveries
• Section 4.18 - Medicaid Premiums and Cost Sharing
  
  • Attachment 4.18
    • G1 – Cost Sharing Requirements
    • G2a – Cost Sharing Amounts – Categorically Needy Individuals
    • G2b – Cost Sharing Amounts – Medically Needy Individuals
    • G2c – Cost Sharing Amounts – Targeting
    • G3 – Cost Sharing Limitations
• Section 4.19 - Payment for Services
  
  • Attachment 4.19a
    
    • Item 1 - Inpatient Hospital Services Reimbursement
    • Item 14a - Services for Individuals 65 or Older in Institutions for Mental Diseases
    • Item 16 - Inpatient Psychiatric Hospital Services for Individuals Under Age 21
  • Attachment 4.19b
    
    • Item 2a - Outpatient Hospital Services
    • Item 2b - Rural Health Clinic Services
    • Item 2c - FQHC Services
    • Item 2d - Reimbursement for Indian Health Services Tribal 638 Facilities
    • Item 3 - Other Laboratory and X-Ray Services
    • Item 4b - EPSDT Services
    • Item 4c - Family Planning Services and Supplies for Individuals of Child Bearing Age
    • Item 5 - Physician Services
    • Item 5b - Medical and Surgical Services Provided by a Dentist
    • Item 6 - Medical and Remedial Care Furnished by Other Licensed Providers
    • Item 7 - Home Health Care Services
    • Item 9 - Clinic Services
    • Item 12a - Prescribed Drugs
    • Item 12b - Dentures
    • Item 12c - Prosthetic Devices
    • Item 13c - Preventive Services
    • Item 13d - Rehabilitative Services
    • Item 17 - Nurse Midwife Services
    • Item 18 - Hospice Care Services
    • Item 19 - Targeted Case Management Services
    • Item 19b - Special Tuberculosis-related Services for Tuberculosis Infected Individuals
    • Item 20a - Pregnancy-related and Postpartum Services
    • Item 20b - Extended Services for Pregnant Women
    • Item 23 - Nurse Practitioner Services
    • Item 24a - Medical Transportation Services
    • Item 24d - Skilled Nursing Facility Services for Individuals under 21
    • Item 26 - Personal Care Services
    • Item 28 - Self-directed Personal Assistance Services
    • Item 28(i) - Free-Standing Birthing Centers
    • Item 29 - Medication-Assisted Treatment
    • Item 30 – Qualifying Clinical Trials
    • Supplement 1 - Payment Rates for Title XIII Part A and Part B Deductible/Coinsurance
  • Attachment 4.19c - Methods of Payment for Reserving Beds During a Recipients Absence from an Inpatient Facility
  • Attachment 4.19d(1) - Payments for Skilled Nursing Facilities
  • Attachment 4.19d(2) - Payments for Intermediate Care Facilities
  • Attachment 4.19e - Timely Claims Payment - Definition of Claim
• Section 4.20 - Direct Payment to Certain Recipients for Physician or Dentist Services
• Section 4.21 - Prohibition Against Reassignment of Provider Claims
• Section 4.22 - Third Party Liability
  
  • Attachment 4.22a - Requirements for Third Party Liability - Identifying Liable Resources
  • Attachment 4.22b - Requirements for Third Party Liability - Payment of Claims
  • Attachment 4.22c - Requirements for Third Party Liability - Cost Effectiveness for Employer Based Group Health Benefit Plans
  • Supplement 1 - State Laws Requiring Third Parties to Provide Coverage Eligibility and Claims Data
• Section 4.23 - Use of Contracts
• Section 4.24 - Standards for Payments for Skilled Nursing and Intermediate Care Facility Services
• Section 4.25 - Program for Licensing Administrators of Nursing Homes
• Section 4.26 - Drug Utilization Program
• Section 4.27 - Disclosure of Survey Information and Provider or Contractor Evaluation
• Section 4.28 - Appeals Process for Skilled Nursing and Intermediate Care Facility Services
• Section 4.29 - Conflict of Interest Provisions
• Section 4.30 - Exclusion of Providers and Suspension of Practitioners and Other Individuals
  
  • Attachment 4.30 - Sanctions for Psychiatric Hospitals
• Section 4.31 - Disclosure of Information by Providers and Fiscal Agents
• Section 4.32 - Income and Eligibility Verification System
  
  • Attachment 4.32a - Income and Eligibility Verification System Procedures - Requests to Other State Agencies
• Section 4.33 - Medicaid Eligibility Cards for Homeless Individuals
  
  • Attachment 4.33a - Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
• Section 4.34 - Systematic Alien Verification for Entitlements
  
  • Attachment 4.34a - Requirements for Advance Directives
• Section 4.35 - Enforcement of Compliance for Nursing Homes
  
  • Attachment 4.35a - Enforcement of Compliance for Nursing Facilities
• Section 4.36 - Required Coordination Between Medicaid and WIC Programs
• Section 4.38 - Nurse Aide Training and Competency Evaluation for Nursing Facilities
  
  • Attachment 4.38 - Collection and Disclosure of Additional Registry Information
• Section 4.39 - Pre-admission Screening and Annual Resident Review in Nursing Facilities
  
  • Attachment 4.39 - Definition of Specialized Services
  • Attachment 4.39a - Categorical Determinations
• Section 4.41 - Resident Assessment for Nursing Facilities
• Section 4.42 - Employee Education About False Claims Recoveries
  
  • Attachment 4.42a - Method of Compliance Oversight and Frequency with which the State will Reassess Compliance
• Section 4.43 - Cooperation with Medicaid Integrity Program Efforts
• Section 4.44 - Prohibition on Payments to Institutions or Entities Located Outside the U.S.
• Section 4.46 - Provider Screening and Enrollment

• Section 5.1 - Standards of Personnel Administration
• Section 5.2 - Reserved
• Section 5.3 - Training Programs - Sub-professional and Volunteer Programs

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

• Section 7.1 - Plan Amendments
• Section 7.2 - Non-discrimination
  
  • Attachment 7.2a - Methods of Administration - Compliance with Civil Rights Act (Title VI)
• Section 7.4 - State Governor's Review
  • Section 7.4.A - Rescissions to Medicaid Disaster Relief COVID-19 National Emergency 
  • Section 7.4.B - Temporary Extensions to the Disaster Relief Policies for the COVID-19 National Emergency
    • 23-0015  LA Medicaid Disaster Relief SPA Signature Waiver (Pharmacy)
    • 23-0019  Long Term-Personal Care Services Disaster Relief Extension
    • 23-0023  Disaster Relief Extension SPA (Long Term-Personal Care Services)
    • 23-0030  Medicaid Disaster Relief Extension (Treatment in Place)
  • Section 7.4.C - Temporary Policies in Effect Following the COVID-19 National Emergency
    • 23-0017 Targeted Case Management
    • 23-0018 Disaster Relief Extension (Long Term - Personal Care Services)
  • Section 7.4.1 - Medicaid Disaster Relief COVID-19 National Emergency
    • Medicaid Disaster Relief Increase Reimbursement Vaccine Administration
    • Medicaid Disaster Relief Laboratory Services
    • Medicaid Disaster Relief Administrative Claiming
    • Medicaid Disaster Relief FQHC and RHC - Alternative Payment Methodology
    • Medicaid Disaster Relief FQHC and RHC - Alternative Payment Methodology COVID-19 Monoclonal Treatment
    • Medicaid Disaster Relief SPA - ICF-IID Direct Care Add-On
    • Medicaid Disaster Relief SPA – Home and Community-Based Services Spending Plan – Targeted Case Management and Personal Care Services
    •  Medicaid Disaster Relief SPA – Home and Community-Based Services - Personal Care Services
• Section 7.7 - COVID-19 Vaccine and Vaccine Administration, Testing, and Treatment
  • Section 7.7-A - COVID-19 Vaccine and Vaccine Administration
  • Section 7.7-B - COVID 19 Testing
  • Section 7.7-C - COVID-19 Treatment