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:
- Click on the Bookmark tab to the left of the plan pages to see a detailed index.
- 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 July 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 These new pages superseded (i.e., replaced) full and partial pages that remain part of the State Plan Attachments. To indicate when a plan page contains superseded information, a red translucent overlay has been added.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.
- 09/30/2019 PNI – SPA 19-0036 Public EMS (PDF) – (Effective October 1, 2019)
- 09/27/2019 PNI – SPA 19-0025 Value Based Rebate Agreement (PDF) – (Effective October 1, 2019)
- 07/03/2019 PNI – SPA Clinical Diagnostic Laboratory Services (PDF) – (Effective July 4, 2019)
- 06/28/2019 PNI – SPA 19-0019 ICF IDD Revised Inflators Revised (PDF) – (Effective July 1, 2019)
- 05/31/2019 PNI – SPA 19-0019 ICF IDD Revised Inflators (PDF) – (Effective June 1, 2019)
- 03/29/2019 PNI - SPA Graduate Medical Education Program for Private Hospital (PDF) - (Effective April 1, 2019)
- 01/29/2019 PNI - Texas State Plan for Medical Assistance Amendments (PDF) - (Effective February 1, 2019)
- 09/28/2018 PNI - Texas State Plan for Medical Assistance Amendment (PDF) - (Effective October 1, 2018)
- 02/05/2018 PNI - SPA 18-0001 Supplemental Drug Rebates Agreement - (Effective February 15, 2018)
- 07/01/2016 PNI SPA 16-0023 Therapy Rates (PDF) - (Effective December 15, 2016)