State Plan

State Plan and Amendments

The state plan is the officially recognized document describing the nature and scope of the State of Texas Medicaid program. As required under Section 1902 of the Social Security Act, the plan was developed by the state and approved by the U.S. Department of Health and Human Services. Essentially, the plan is the state's agreement that it will conform to the requirements of the Social Security Act and the official issuances of the U.S. Department of Health and Human Services.

Plan changes are submitted by the state to the U.S. Department of Health and Human Services as state plan amendments. Through the Centers for Medicare and Medicaid Services, HHS reviews each SPA to determine whether it meets federal requirements and policies. The plan is updated when CMS issues final approval of a SPA.

The plan on this website is for informational purposes only and is not legally binding. The official plan is maintained by CMS Region 6.

Once the plan file is opened, specific sections of the plan are accessible in one of two ways:

  1. Click on the Bookmark tab to the left of the plan pages to see a detailed index.
  2. Use the search function to find information within the plan by key words or phrases. Please remember that since the documents are PDF, the search function is not 100 percent accurate in all circumstances.

Approved state plan amendments will be posted as updates are made to the plan.

Persons with disabilities having problems accessing PDF files may email HHSC Medicaid Chip SPA Inquiries for assistance.

This plan is current as of October 31, 2019.

The electronic version of the Texas Medicaid State Plan Attachments pages contain new templates from CMS. These new pages superseded (i.e., replaced) full and partial pages that remain part of the State Plan Attachments. To indicate when a plan page contains superseded information, a red translucent overlay has been added. The top left corner of each overlay contains information about the new pages that supersede that section. Mousing over or clicking the comment box will open a dialog box that indicates which new pages supersede the pages or sections contained inside the red translucent box.

Amendments to the 2019 Texas State Medicaid Plan Approved by CMS

SPA Transmittal Number Effective Date SPA Topic Disposition Date
19-0001 (PDF) 01/01/2019 Physicians for Anesthesia Fees 01/30/2019
19-0002 (PDF) 01/01/2019 Clinical Diagnostic Lab Fees 04/17/2019
19-0003 (PDF) 01/01/2019 Chemical Dependency Treatment Facility (CDTF) 04/17/2019
19-0004 (PDF) 01/01/2019 Physicians Fees 04/18/2019
19-0005 (PDF) 01/01/2019 EPSDT Fees 04/18/2019
19-0006 (PDF) 01/01/2019 DMEPOS Fees 04/19/2019
19-0007 (PDF) 03/01/2019 Physicians Anesthesia Fees 05/07/2019
19-0008 (PDF) 03/01/2019 Family Planning Fees 04/22/2019
19-0009 (PDF) 01/01/2019 DAHS Cost Report Form 06/24/2019
19-0010 (PDF) 01/01/2019 HCBS Cost Report Form 06/24/2019
19-0011 (PDF) 01/01/2019 ICF/IDD Cost Projection Methodology 05/13/2019
19-0012 (PDF) 01/01/2019 NF Cost Report Form 06/03/2019
19-0013 (PDF) 01/01/2019 Primary Home Care Cost Report Form 06/24/2019
19-0016 (PDF) 04/01/2019 DMEPOS Fees 07/17/2019
19-0017 (PDF) 04/01/2019 EPSDT Fees 07/18/2019
19-0018 (PDF) 04/01/2019 Physicians Fees 07/19/2019

Archived State Plan Amendments

2018 State Plan Amendments

SPA Transmittal Number Effective Date SPA Topic Disposition Date
18-0001 (PDF) 02/15/2018 Supplemental Drug Rebates Agreement 05/15/2018
18-0002 (PDF) 01/01/2018 Clinical Diagnostic Laboratory Fees 04/06/2018
18-0003 (PDF) 01/01/2018 Physicians Fees 04/18/2018
18-0004 (PDF) 01/01/2018 Early and Periodic Screening, Diagnosis, and Treatment Fees 04/25/2018
18-0005 (PDF) 01/01/2018 Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fees 04/18/2018
18-0006 (PDF) 01/01/2018 Family Planning Fees 04/19/2018
18-0007 (PDF) 03/01/2018 Intermediate Care Facilities for Individuals with Intellectual Disabilities 05/23/2018
18-0008 (PDF) 04/01/2018 Early and Periodic Screening, Diagnosis, and Treatment Fees 06/29/2018
18-0009 (PDF) 04/01/2018 Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fees 06/29/2018
18-0010 (PDF) 04/01/2018 Physicians Fees 07/02/2018
18-0011 (PDF) 09/01/2019 Peer Specialist Services 12/14/2018
18-0012 (PDF) 06/01/2018 Physicians Fees 07/26/2018
18-0013 (PDF) 07/01/2018 Clinical Diagnostic Laboratory Fees 09/07/2018
18-0014 (PDF) 07/01/2018 Early and Periodic Screening, Diagnosis, and Treatment Fees 09/07/2018
18-0015 (PDF) 07/01/2018 Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fees 09/07/2018
18-0016 (PDF) 07/01/2018 Physicians Fees 09/10/2018
18-0017 (PDF) 07/01/2018 Recovery Audit Contractor 09/13/2018
18-0018 (PDF) 09/01/2018 Ambulance Services Fee 10/10/2018
18-0019 (PDF) 09/01/2018 Early and Periodic Screening, Diagnosis, and Treatment Fees 10/10/2018
18-0020 (PDF) 10/01/2018 Physicians Fees 01/23/2019
18-0021 (PDF) 10/01/2018 Early and Periodic Screening, Diagnosis, and Treatment Fees 01/24/2019
18-0022 (PDF) 10/01/2018 Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fees 01/24/2019
18-0024 (PDF) 10/01/2018 Graduate Medical Education 02/21/2019

 

2017 State Plan Amendments

SPA Transmittal Number Effective Date SPA Topic Disposition Date
17-0001 (PDF) 02/15/2017 Deletion of Targeted Case Management for Blind Children 11/06/2017
17-0002 (PDF) 09/01/2017 Federally Qualified Health Centers 10/03/2017
17-0003 (PDF) 01/01/2017 Clinical Diagnostic Lab Fees 05/01/2017
17-0004 (PDF) 01/01/2017 Physicians Fees 06/01/2017
17-0005 (PDF) 01/01/2017 Early and Periodic Screening, Diagnosis, and Treatment Fees 05/01/2017
17-0006 (PDF) 01/01/2017 Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fee 05/01/2017
17-0007 (PDF) 01/01/2017 Family Planning Fees 05/01/2017
17-0008 (PDF) 02/01/2017 Physicians Fees 06/01/2017
17-0009 (PDF) 02/01/2017 Hospital Outpatient Reimbursement for Imaging 05/01/2017
17-0010 (PDF) 03/01/2017 Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fee 05/01/2017
17-0011 (PDF) 04/01/2017 Covered Outpatient Drug 09/22/2017
17-0012 (PDF) 04/01/2017 Physicians Fees 07/17/2017
17-0013 (PDF) 04/01/2017 Early and Periodic Screening, Diagnosis, and Treatment Fees 07/17/2017
17-0014 (PDF) 04/01/2017 Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fees 07/17/2017
17-0015 (PDF) 07/01/2017 Clinical Laboratory Services 09/15/2017
17-0016 (PDF) 07/01/2017 Physicians Fees 10/11/2017
17-0017 (PDF) 10/01/2017 Early and Periodic Screening, Diagnosis, and Treatment Fees 02/02/2018
17-0018 (PDF) 09/01/2017 Non-Emergency Medical Transportation 10/03/2017
17-0019 (PDF) 10/01/2017 Administrative Update Inpatient Hospital Services 12/08/2017
17-0020 (PDF) 12/01/2017 Pre-admission Screening and Resident Review Specialized Services 10/23/2017
17-0021 (PDF) 09/01/2017 Therapy Fees 12/11/2017
17-0022 (PDF) 11/01/2017 Anesthesia Fees 02/06/2018
17-0023 (PDF) 10/01/2017 Physicians Fees 02/02/2018
17-0024 (PDF) 08/01/2017 Correction to 16-0024 TANF Work Requirement 12/13/2017
17-0025 (PDF) 10/01/2017 Chemical Dependency Treatment Facility 02/02/2018

2016 State Plan Amendments

SPA Transmittal Number Effective Date SPA Topic Disposition Date
16-0001 (PDF) 07/01/2016 Pre-admission Screening and Resident Review Specialized Services 12/21/2017
16-0002 (PDF) 01/01/2016 Federally Qualified Health Centers and Rural Health Clinics 02/25/2016
16-0003 (PDF) 08/01/2016 School-Based Savings Program 08/29/2016
16-0004 (PDF) 05/15/2015 Potentially Preventable Events Incentives 05/24/2016
16-0005 (PDF) 04/01/2016 MAGI Marriage Eligibility Policy 05/02/2016
16-0006 (PDF) 10/01/2016 Program for All Inclusive Care for the Elderly Reimbursement Methodology 08/02/2016
16-0007 (PDF) 10/01/2016 Clinical Diagnostic Laboratories Fees 06/06/2016
16-0008 (PDF) 10/01/2016 Early and Periodic Screening, Diagnosis, and Treatment Fees 06/06/2016
16-0009 (PDF) 10/01/2016 Family Planning Fees 06/06/2016
16-0010 (PDF) 10/01/2016 Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fees 06/06/2016

Public Notice of Intent (PNI) for State Plan Amendments

PNIs at this website address are updated and maintained in accordance with 42 CFR § 447.205(d)(iv). The date reflects the posting date.