What is a State Plan?
A State Plan is an agreement between a state and the federal government that explains how the state runs its Medicaid program. It shows that the state follows federal rules and allows it to receive federal funding for Medicaid services. The plan outlines who is covered, what services are offered, how providers are paid, and the rules the state must follow.
States often submit a State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS) when they want to make changes. These changes might be required by new laws, regulations, court decisions, or simply to correct or update information.
Questions or comments?
Contact Jennifer Steenblock at: jennifer.steenblock@hhs.iowa.gov
State Plan Amendment Sections
- 1.1 Designation and Authority
- 1.2 Organization for Administration
- 1.3 Statewide Operation
- 1.4 Tribal Consultation Requirement
- 1.5 Pediatric Immunization Program
4.2 Hearings for Applicants and Recipients
4.3 Safeguarding Information on Applicants and Recipients
4.5 Medicaid Agency Fraud Detection and Investigation Program
4.8 Availability of Agency Program Manuals
4.9 Reporting Provider Payments to the Internal Revenue Service
4.11 Relations with Standard‑Setting and Survey Agencies
4.12 Consultation to Medical Facilities
4.13 Required Provider Agreement
4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
4.18 Cost Sharing and Similar Charges
4.20 Direct Payments to certain Recipients for Physicians' or Dentists' Services
4.21 Prohibition Against Reassignment of Provider Claims
4.24 Standards for Payments for Skilled Nursing and Intermediate Care Facility Services
4.25 Program for Licensing Administrators of Nursing Homes
4.27 Disclosure of Survey information and Provider or Contractor Evaluation
4.28 Appeals Process for Skilled Nursing and Intermediate Care Facilities
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
4.32 Income and Eligibility Verification System
4.33 Medicaid Eligibility Cards for Homeless Individuals
4.34 Systematic Alien Verification for Entitlements
4.36 Required Coordination Between the Medicaid and WIC Programs
4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities
4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities
4.40 Survey & Certification Process
4.41 Resident Assessment for Nursing Facilities
4.42 Determining Eligibility For Medicare Prescription Drug Low-Income Subsidies
4.43 Employee Education About False Claims Recoveries
Medicaid State Plan Eligibility
S10 MAGI Based Income Methodologies
S16 Presumptive Eligibility for Children
S21 Presumptive Eligibility by Hospitals
S25 Eligibility Groups - Mandatory Coverage - Parents and Other Caretaker Relatives
S28 Eligibility Groups - Mandatory Coverage - Pregnant Women
S30 Eligibility Groups - Mandatory Coverage - Infants and Children Under Age 19
S32 Eligibility Groups - Mandatory Coverage - Adults
S33 Eligibility Groups - Mandatory Coverage - Former Foster Care Children
S50 Eligibility Groups - Options for Coverage - Individuals Above 133% Federal Poverty Level (FPL)
S51 Eligibility Groups - Options for Coverage - Coverage of Parents and Other Caretaker Relatives
S53 Eligibility Groups - Options for Coverage - Children with Non IV-E Adoption Assistance
S54 Eligibility Groups - Options for Coverage - Optional Targeted Low Income Children
S55 Eligibility Groups - Options for Coverage - Individuals with Tuberculosi
S57 Eligibility Groups - Options for Coverage - Independent Foster Care Adolescents
S59 Eligibility Groups - Options for Coverage - Individuals Eligible for Family Planning Services
S88 Non-Financial Eligibility - State Residency
S89 Non-Financial Eligibility - Citizenship and Non-Citizen Eligibility
1.1-A Attorney General's Certification
1.1-B Waivers under the Intergovernmental Cooperation Act
1.2-A Organization and Function of State Agency
1.2-B Organization and Function of Medical Assistance Unit
1.2-C Professional Medical and Supporting Staff
1.2-D Description of Staff Making Eligibility Determination
2.1-A Definition of an HMO That Is Not Federally Qualified
2.2-A Groups Covered and Agencies Responsible for Eligibility Determination
2.6-A Eligibility Conditions and Requirements (States only)
- Supplement 1
- Supplement 2
- Supplement 3
- Supplement 4
- Supplement 5
- Supplement 6
- Supplement 7
- Supplement 8
- Supplement 9
- Supplement 10
- Supplement 11
- Supplement 12
- Supplement 13
- Supplement 16
- Supplement 17
3.1-C Standards and Methods of Assuring High Quality Care
3.1-D Methods of Providing Transportation
3.1-E Standards for the Coverage of Organ Transplant Procedures
3.1-L Iowa Marketplace Choice Plan
4.11-A Standards for Institutions
4.14-A Single Utilization Review Methods for Intermediate Care Facilities
4.14-B Multiple Utilization Review Methods for Intermediate Care Facilities
4.16-A Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies and with Title V Grantees
4.17-A Determining that an Institutionalized Individual Cannot Be Discharged and Returned Home
4.18-A Charges Imposed on Categorically Needy
4.18-D Premiums Imposed on Low Income Pregnant Women and Infants
4.18-E Premiums Imposed on Qualified Disabled and Working Individuals
4.19-A Methods and Standards for Establishing Payment Rates - Inpatient Hospital Care
4.19-B Methods and Standards for Establishing Payment Rates - Other Types of Care
4.19-C Payments for Reserved Beds
4.22-A Requirements for Third Party Liability - Identifying Liable Resources
4.22-B Requirements for Third Party Liability - Payment of Claims
4.22-C Cost-Effective Methods for Employer-Based Group Health Plans
4.32-A Income and Eligibility Verification System Procedures: Requests to Other State Agencies
4.33-A Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance
4.35-A Eligibility Conditions and Requirements: Enforcement of Compliance for Nursing Facilities
4.35-B Eligibility Conditions and Requirements: Enforcement of Compliance for Nursing Facilities
4.35-C Eligibility Conditions and Requirements: Enforcement of Compliance for Nursing Facilities
4.35-D Eligibility Conditions and Requirements: Enforcement of Compliance for Nursing Facilities
4.35-E Eligibility Conditions and Requirements: Enforcement of Compliance for Nursing Facilities
4.35-F Eligibility Conditions and Requirements: Enforcement of Compliance for Nursing Facilities
4.35-G Eligibility Conditions and Requirements: Enforcement of Compliance for Nursing Facilities
4.35-H Eligibility Conditions and Requirements: Enforcement of Compliance for Nursing Facilities
4.35-I Eligibility Conditions and Requirements: Enforcement of Compliance for Nursing Facilities
4.39-A Preadmission Screening and Annual Resident Review in Nursing Facilities
4.40-A Eligibility Conditions and Requirements: Survey and Certification Education Program
4.40-D Eligibility Conditions and Requirements: Programs to Measure and Reduce Inconsistency
4.43-A Frequency and Description of Method of Compliance and Oversight
7.2-A Methods of Administration - Civil Rights (Title VI)
7.4-A Recission to the State's Disaster Relief Policies for the COVID-19 National Emergency