Medicaid State Plan Attachments

List of Attachments [ 135.9 kB ]

• 1.1-A Attorney General's Certification [ 52.9 kB ]
• 1.1-B Waivers under the Intergovernmental Cooperation Act [ 4.2 MB ]
• 1.2-A Organization and Function of Medicaid State Agency [ 113.5 kB ]
• 1.2-B Organization and Function of Medicaid Office [ 636.8 kB ]
• 1.2-C Professional Medical and Supporting Staff [ 78.8 kB ]
• 1.2-D Description of Staff Making Eligibility Determination [ 38.7 kB ]
• 2.1-A Definition of a Health Maintenance Organization [ 92.4 kB ]
• 2.2-A Groups Covered and Agencies Responsible for Eligibility Determinations [ 1.3 MB ]
• 2.6-A Eligibility Conditions and Requirements [ 3 MB ] Updated September 14, 2015
• 3.1-A Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy [ 11.3 MB ] Updated March 25, 2024
• 3.1-B Amount, Duration, and Scope of Services Provided Medically Needy Groups [ 3.2 MB ] Updated March 25, 2024
• 3.1-C Standards and Methods of Assuring High-Quality Care [ 42.7 kB ]
• 3.1-D Methods of Providing Transportation [ 83.7 kB ] Updated December 27, 2021
• 3.1-E Standards for the Coverage of Organ Transplant Procedures [ 53.7 kB ] Updated August 11, 2015
• 3.2-A Coordination of Title XIX with Part A and Part B of Title XVIII [ 42.5 kB ]
• 4.11-A Standards for Institutions [ 23.7 kB ]
• 4.14-B Methods of Utilization Review in Facilities and Institutions [ 35.7 kB ] Updated March 30, 2016
• 4.16-A Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies and with Title Five Grantees, Parts I - XIII [ 2.1 MB ]
• 4.17-A Liens and Adjustments or Recoveries [ 425.4 kB ]
• 4.18-A Charges Imposed on Categorically Needy [ 151.8 kB ]
• 4.18-B Methods for Establishing Payment Rates - Emergency Services [ 11.6 kB ]
• 4.18-C Charges Imposed on Medically Needy and Other Optional Groups [ 149.7 kB ]
• 4.18-D Premiums Imposed on Low-Income Pregnant Women and Infants [ 43.3 kB ]
• 4.18-E Premiums Imposed on Qualified Disabled and Working Individuals [ 43.5 kB ]
• 4.19-A Methods and Standards for Establishing Payment Rates [ 1.1 MB ] Updated November 6, 2024
• 4.19-B Methods and Standards for Establishing Payment Rates - Other Types of Care [ 3.6 MB ] Updated November 6, 2024
• 4.19-C Payments for Reserved Beds [ 45.5 kB ] Updated March 30, 2016
• 4.19-D Methods and Standards for Establishing Payment Rates [ 6.3 MB ] Updated November 6, 2024
• 4.19-E Timely Claims Payment - Definition of Claim [ 211.8 kB ]
• 4.20-A Conditions for Direct Payment- for Physicians and Dentist Services [ 8.6 kB ]
• 4.22-A Requirements for Third-Party Liability - Identifying Liable Resources [ 135.1 kB ]
• 4.22-B Requirements for Third-Party Liability - Payment for Claims [ 123.3 kB ]
• 4.22-C Employer Based Group Health Insurance [ 91.7 kB ]
• 4.30 Sanctions for Psychiatric Hospitals [ 75.4 kB ]
• 4.32-A Income and Eligibility Verification System Procedures: Requests to other State Agencies [ 57.3 kB ]
• 4.33-A Method of Issuance of Medicaid Eligibility Cards to Homeless Individuals [ 26 kB ] Updated July 5, 2016
• 4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance [ 182.2 kB ]
• 4.35-A through 4.35-H Enforcement of Compliance for Nursing Facilities [ 152 kB ]
• 4.38 Disclosure of Additional Registry Information [ 35.1 kB ]
• 4.38-A Collection of Additional Registry Information [ 11.7 kB ]
• 4.39 Definition of Specialized Services [ 14.7 kB ]
• 4.39-A Categorical Determinations [ 51.2 kB ]
• 4.40-A through 4.40-E Eligibility Conditions and Requirements [ 216.9 kB ]
• 4.42-A Employee Education About False Claims Recovery [ 21.2 kB ]
• 7.2-A Methods of Administration [ 17.3 kB ]
• Supplement 1 Medicaid Eligibility
• Supplement 2 Women, Infants, and Children (WIC) Program
• Supplement 3 Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
• Supplement 4 Healthy Start
• Supplement 5 Utilization Control for Institutional Care
• Supplement 1 Reasonable Classification of Individuals under the Age of 21, 20, 19 and 18
• Supplement 3 Method of Determining Cost Effectiveness of Caring for Certain Disabled Children at Home
• Supplement 1 Income Eligibility Levels - Categorically Needy, Medically Needy and Qualified Medicare Beneficiaries
• Supplement 2 Resource Levels Categorically Needy, Including Groups with Incomes Up to a Percentage of the Federal Poverty Level, Medically Needy, and other Optional Groups
• Supplement 3 Post Eligibility Treatment of Institutionalized Individuals' Incomes
• Supplement 4 Section 1902(f) Methodologies for Treatment of Income that Differ from those of the SSI Program
• Supplement 5 Section 1902(f) Methodologies for Treatment of Resources that Differ from those of the SSI Program
• Supplement 5a Methodologies for Treatment of Resources for Individuals with Incomes Up to a Percentage of the Federal Poverty Level
• Supplement 6 Standards for Optional State Supplementary Payments
• Supplement 7 Variations from the Basic Personal Needs Allowance – Territories
• Supplement 8 Resource Standards for 1902(f) States Categorically Needy
• Supplement 8a More Liberal Methods of Treating Income Under Section 1902(r)(2) of the Act
• Supplement 8b More Liberal Methods of Treating Resources Under Section 1902(r)(2) of the Act
• Supplement 8c Long-Term Care Insurance Partnership
• Supplement 9 Transfer of Resources
• Supplement 9b Transfer of Assets
• Supplement 10 Consideration of Medicaid Qualifying Trusts--Undue Hardship
• Supplement 12 Eligibility Under Section 1931 of the Act
• Supplement 13 Section 1924 Provisions (Income and Resource Eligibility)
• Supplement 14 Income and Resource Requirements for Tuberculosis (TB) Infected Individuals
• Supplement 15 Variations from the Basic Personal Needs Allowance
• Supplement 16 Asset Verification System
• Supplement 17 Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity
• Supplement 1 Case Management Services
• Supplement 2 Alternative Health Care Plans for Families Covered Under Section 1925 of the Act
• Supplement 3 PACE Services
• Supplement 4 1915(j) Self-Directed Personal Assistance Services
• Supplement 5 1915(i) State Plan and Community-Based Services
• Appendix A-1 and A-2 to Supplement 2 - Medicaid Eligibility Groups Served
• Appendix B1 through B3 to Supplement 2 - Functional Disability
• Appendix C1 and C2 to Supplement 2 - Definition of Services
• Appendix D1 and D2 to Supplement 2 - Assessment
• Appendix E1 through E3 to Supplement 2 - Individual Community Care Plan (ICCP)
• Appendix F1 through F3 to Supplement 2 - Rights Specified in the Statute
• Appendix G1 through G5 to Supplement 2 - Community Care Settings
• Supplement 1 Organ-Tissue Transplantation Standards [ 86.4 kB ]
• Interstate Compact on Adoption and Medical Assistance [ 295.2 kB ]
• Part I: Inpatient Hospital Care
• Part II: Emergency Services
• Part III: Inpatient Psychiatric Services
• Part IV: Cancer Hospitals
• Supplement 1 Payment of Medicare Part A and Part B Deductible/Coinsurance
• Supplement 2 Federally Qualified Health Center and Rural Health Clinic
• Supplement 3 County Health Department Reimbursement Plan
• Exhibit I: Outpatient Hospital Reimbursement Plan
• Exhibit II: Practitioner Reimbursement Methodology
• Part I: Long-Term Care
• Part II: Intermediate Care Facility for Individuals with Intellectual Disabilities Publicly Owned
• Part III: Intermediate Care Facility for Individuals with Intellectual Disabilities Not Publicly Owned

Sections of the State Plan

To find the sections of the state plan, please go to the following link: Sections of the State Plan.