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 Latisha McGuire at: latisha.mcguire@hhs.iowa.gov
State Plan Amendment Sections
- Designation and Authority (189.87 KB) .pdf
- Eligibility Determinations and Fair Hearings (272.4 KB) .pdf
- Organization and Administration (439.6 KB) .pdf
- Single State Agency Assurances (236.35 KB) .pdf
- 1.4 Tribal Consultation Requirement (1.23 MB) .pdf
- 1.5 Pediatric Immunization Program (89.8 KB) .pdf
- 2.1 Application, Determination of Eligibility and Furnishing Medicaid (226.74 KB) .pdf
- 2.2 Coverage and Conditions of Eligibility (226.74 KB) .pdf
- 2.3 Residence (226.74 KB) .pdf
- 2.4 Blindness (226.74 KB) .pdf
- 2.5 Disability (226.74 KB) .pdf
- 2.6 Financial Eligibility (226.74 KB) .pdf
- 2.7 Medicaid Furnished Out of State (226.74 KB) .pdf
3.1 Amount, Duration and Scope of Services (636.55 KB) .pdf
3.2 Coordination of Medicaid with Medicare and Other Insurance (636.55 KB) .pdf
3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases (636.55 KB) .pdf
3.4 Special Requirements Applicable to Sterilization Procedures (636.55 KB) .pdf
3.5 Families Receiving Extended Medicaid Benefits (636.55 KB) .pdf
4.1 Methods of Administration (13.93 KB) .pdf
4.2 Hearings for Applicants and Recipients (13.9 KB) .pdf
4.3 Safeguarding Information on Applicants and Recipients (14.76 KB) .pdf
4.4 Medicaid Quality Control (16.46 KB) .pdf
4.5 Medicaid Agency Fraud Detection and Investigation Program (688.96 KB) .pdf
4.7 Maintenance of Records (20.6 KB) .pdf
4.8 Availability of Agency Program Manuals (21.25 KB) .pdf
4.9 Reporting Provider Payments to the Internal Revenue Service (18.96 KB) .pdf
4.10 Free Choice of Providers (30.34 KB) .pdf
4.11 Relations with Standard‑Setting and Survey Agencies (29.83 KB) .pdf
4.12 Consultation to Medical Facilities (21.04 KB) .pdf
4.13 Required Provider Agreement (62.76 KB) .pdf
4.14 Utilization Control (100.53 KB) .pdf
4.17 Liens and Recoveries (131.49 KB) .pdf
4.18 Cost Sharing and Similar Charges (165.59 KB) .pdf
4.19 Payment for Services (190.15 KB) .pdf
4.20 Direct Payments to certain Recipients for Physicians' or Dentists' Services (20.66 KB) .pdf
4.21 Prohibition Against Reassignment of Provider Claims (15.06 KB) .pdf
4.22 Third Party Liability (314.33 KB) .pdf
4.23 Use of Contracts (22.11 KB) .pdf
4.25 Program for Licensing Administrators of Nursing Homes (19 KB) .pdf
4.26 RESERVED (138.04 KB) .pdf
4.27 Disclosure of Survey information and Provider or Contractor Evaluation
4.28 Appeals Process for Skilled Nursing and Intermediate Care Facilities (18.25 KB) .pdf
4.29 Conflict of Interest Provisions (19.55 KB) .pdf
4.31 Disclosure of Information by Providers and Fiscal Agents (29.57 KB) .pdf
4.32 Income and Eligibility Verification System (29.57 KB) .pdf
4.33 Medicaid Eligibility Cards for Homeless Individuals (17.11 KB) .pdf
4.34 Systematic Alien Verification for Entitlements (19.72 KB) .pdf
4.36 Required Coordination Between the Medicaid and WIC Programs (15.4 KB) .pdf
4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities (142.5 KB) .pdf
4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities (37.05 KB) .pdf
4.40 Survey & Certification Process (83.25 KB) .pdf
4.41 Resident Assessment for Nursing Facilities (20.85 KB) .pdf
4.42 Determining Eligibility For Medicare Prescription Drug Low-Income Subsidies (20.59 KB) .pdf
4.43 Employee Education About False Claims Recoveries (68.91 KB) .pdf
4.44 Cooperation with Medicaid Integrity Program Efforts (13.79 KB) .pdf
Medicaid State Plan Eligibility (263.92 KB) .pdf
S10 MAGI Based Income Methodologies (77.6 KB) .pdf
S14 AFDC Income Standards (288.1 KB) .pdf
S16 Presumptive Eligibility for Children (96.09 KB) .pdf
S21 Presumptive Eligibility by Hospitals (2.62 MB) .pdf
S25 Eligibility Groups - Mandatory Coverage - Parents and Other Caretaker Relatives (238.9 KB) .pdf
S28 Eligibility Groups - Mandatory Coverage - Pregnant Women (370.21 KB) .pdf
S30 Eligibility Groups - Mandatory Coverage - Infants and Children Under Age 19 (622.27 KB) .pdf
S32 Eligibility Groups - Mandatory Coverage - Adults (172.64 KB) .pdf
S33 Eligibility Groups - Mandatory Coverage - Former Foster Care Children (154 KB) .pdf
S55 Eligibility Groups - Options for Coverage - Individuals with Tuberculosi (39.03 KB) .pdf
S57 Eligibility Groups - Options for Coverage - Independent Foster Care Adolescents (144.49 KB) .pdf
S88 Non-Financial Eligibility - State Residency (247.1 KB) .pdf
S89 Non-Financial Eligibility - Citizenship and Non-Citizen Eligibility (133.95 KB) .pdf
S94 General Eligibility Requirements - Eligibility Process (138.77 KB) .pdf
IA Attorney General Certification Signed (64.69 KB) .pdf
HHS Agency-Wide TO Program Names (12.2023) (85.26 KB) .pdf
HHS Division of Compliance - TO (12.2023) (47.3 KB) .pdf
2.1-A Definition of an HMO That Is Not Federally Qualified (44.86 KB) .pdf
2.2-A Groups Covered and Agencies Responsible for Eligibility Determination (1 MB) .pdf
2.6-A Eligibility Conditions and Requirements (States only) (1.62 MB) .pdf
- Supplement 1 (59.29 KB) .pdf
- Supplement 2 (36.65 KB) .pdf
- Supplement 3 (24.24 KB) .pdf
- Supplement 4 (19.57 KB) .pdf
- Supplement 5 (65.4 KB) .pdf
- Supplement 6 (122.72 KB) .pdf
- Supplement 7 (14.51 KB) .pdf
- Supplement 8 (13.34 KB) .pdf
- Supplement 9 (209.72 KB) .pdf
- Supplement 10 (38.37 KB) .pdf
- Supplement 11 (17.62 KB) .pdf
- Supplement 12 (165.6 KB) .pdf
- Supplement 13 (25.87 KB) .pdf
- Supplement 16 (74.99 KB) .pdf
- Supplement 17 (283.72 KB) .pdf
3.1-C Standards and Methods of Assuring High Quality Care (4.58 MB) .pdf
3.1-D Methods of Providing Transportation (1.14 MB) .pdf
3.1-E Standards for the Coverage of Organ Transplant Procedures (66.32 KB) .pdf
3.1-L Iowa Marketplace Choice Plan (1.78 MB) .pdf
3.1-L Iowa Wellness Plan (12.21 MB) .pdf
4.11-A Standards for Institutions (25.3 KB) .pdf
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
4.18-A Charges Imposed on Categorically Needy (30.01 KB) .pdf
4.18-D Premiums Imposed on Low Income Pregnant Women and Infants (27.09 KB) .pdf
4.18-E Premiums Imposed on Qualified Disabled and Working Individuals (27.45 KB) .pdf
4.19-A Methods and Standards for Establishing Payment Rates - Inpatient Hospital Care (6.03 MB) .pdf
4.19-B Methods and Standards for Establishing Payment Rates - Other Types of Care (21.46 MB) .pdf
4.19-C Payments for Reserved Beds (97.05 KB) .pdf
- Supplement 1 (14.35 KB) .pdf
- Supplement 2 (13.46 KB) .pdf
- Supplement 3 (495.96 KB) .pdf
- Supplement 4 (1.01 MB) .pdf
- Supplement 5 (166.76 KB) .pdf
4.22-A Requirements for Third Party Liability - Identifying Liable Resources (88.46 KB) .pdf
4.22-B Requirements for Third Party Liability - Payment of Claims (71.57 KB) .pdf
4.22-C Cost-Effective Methods for Employer-Based Group Health Plans (50.96 KB) .pdf
4.33-A Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals (16.64 KB) .pdf
4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance (66.8 KB) .pdf
4.39-A Preadmission Screening and Annual Resident Review in Nursing Facilities (761.03 KB) .pdf
4.43-A Frequency and Description of Method of Compliance and Oversight (44.82 KB) .pdf
7.2-A Methods of Administration - Civil Rights (Title VI)
7.7-A Vaccine and Vaccine Administration (191.95 KB) .pdf