Medicaid State Plan

Section 1 - Single State Agency Organization

Section 1 [PDF] – Single State Agency Organization

1.0 Designation and Authority
1.1 Attorney General’s Certificate

1.2 Organization and Administration

1.3 Statewide Operation
1.4 State Medical Care Advisory Committee
1.5 Pediatric Immunization

Section 2 - Coverage and Eligibility

Section 2 [PDF] – Coverage and Eligibility

Index, Attachments and Supplements
2.1 Application, Determination of Eligibility and Furnishing Medicaid

2.2 Coverage and Conditions of Eligibility

2.3 Residence
2.4 Blindness
2.5 Disability
2.6 Financial Eligibility

2.7 Medicaid Furnished Out of State

Section 3 - Services: General Provisions

Section 3 [PDF] – Services: General Provisions

Index, Attachments and Supplements
3.1 Amount, Duration and Scope of Services

3.2 Coordination of Medicaid with Medicare and Other Insurance

3.3 Medicaid for Individuals Aged 65 and Over in Institutions for Mental Disease
3.4 Special Requirements Applicable to Sterilization Procedures
3.5 Families Receiving Extended Medicaid Benefits
3.6 Unemployed Parents

Section 4 - General Program Administration

Section 4 [PDF] – General Program Administration (4.1 – 4.14)

Index, Attachments and Supplements
4.1 Methods of Administration
4.2 Hearings for Applicants and Recipients
4.3 Safeguarding Information on Applicants and Recipients
4.4 Medicaid Quality Control
4.5 Medicaid Agency Fraud Detection and Investigation Program

4.6 Reports
4.7 Maintenance of Records
4.8 Availability of Agency Program Manuals
4.9 Reporting Provider Payments to the Internal Revenue Service
4.10 Free Choice of Providers
4.11 Relations with Standard-Setting and Survey Agencies

4.12 Consultation to Medical Facilities
4.13 Required Provider Agreement
4.14 Utilization/ Quality Control

Section 4 [PDF] – General Program Administration (4.15 – 4.19)

Index, Attachments and Supplements
4.15 Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Disease

4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees

4.17 Liens and Recoveries

4.18 Cost Sharing and Similar Charges

4.19 Payment for Services

Section 4 [PDF] – General Program Administration (4.20 – 4.40)

Index, Attachments and Supplements
4.20 Direct Payments to certain Recipients for Physicians’ or Dentists’ Services
4.21 Prohibition Against Reassignment of Provider Claims
4.22 Third Party Liability

4.23 Use of Contracts
4.24 Standards for Payments for Skilled Nursing and Intermediate Care Facilities for Mentally Retarded Services
4.25 Program for Licensing Administrators of Nursing Homes
4.26 Drug Utilization Review Program
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

4.35 Enforcement of Compliance for Nursing Facilities

4.36 Required Coordination Between the Medicaid and WIC Programs
4.40

4.42

4.43 Cooperation with Medicaid Integrity Efforts

4.44

4.46 Provider Screening and Enrollment

 4.5 Medicaid Recovery Audit Contractor Program
Section 5 - Personnel Administration

Section 5 [PDF] – Personnel Administration

Index, Attachments and Supplements
5.1 Standards of Personnel Administration
5.2 Reserved
5.3 Training Programs; Sub-Professional and Volunteer Program

Section 6 - Financial Administration

Section 6 [PDF] – Financial Administration

Index, Attachments and Supplements
6.1 Fiscal Policies and Accountability
6.2 Cost Allocation
6.3 State Financial Participation

Section 7 - General Provisions

Section 7 [PDF] – General Provisions

Index, Attachments and Supplements
7.1 Plan Amendments
7.2 Nondiscrimination

7.4 State Governor’s Review

Waivers

The Social Security Act authorizes multiple waiver and demonstration authorities to allow states flexibility in operating Medicaid programs. Each authority has a distinct purpose, and distinct requirements.

Please select the Waiver or Demonstration project of interest.

Current Home and Community Based Waivers

 

Additional information about DC Waiver and Demonstration projects is available at:
www.adrcdc.org