Medicaid State Plan Amendments

California Medicaid DRG Payment Parameters Update

CMS approved California State Plan Amendment CA-25-0022, updating DRG payment parameters for State Fiscal Year 2025-26 for general acute inpatient services. The amendment affects private hospitals, non-designated public hospitals, out-of-state hospitals, and critical access hospitals. A companion letter clarifies that CMS is not approving payment methodologies that may violate the Asante v. Kennedy circuit court opinion.

Vermont Mental Health Services State Plan Amendment

CMS approved Vermont State Plan Amendment 25-0009, which transfers rehabilitation mental health services from the Global Commitment to Health 1115 waiver to the State Plan. The amendment, effective July 1, 2025, updates Vermont's Community Mental Health Center services under 42 CFR §440.130.

New Jersey Adds CCBHC Services and Payment Methodologies

CMS approved New Jersey's Medicaid State Plan Amendment (SPA 25-0017) to add Certified Community Behavioral Health Clinic (CCBHC) services and establish payment methodologies for these services. The amendment was approved on March 27, 2026, with an effective date of October 1, 2025. CCBHCs provide integrated behavioral health services to individuals with mental health and substance use disorders.

Massachusetts Adult Foster Care Reimbursement Rates

CMS approved Massachusetts State Plan Amendment MA-25-0034 updating Adult Foster Care (AFC) reimbursement rates effective November 1, 2025. The amendment supersedes the previous version (24-0029) and establishes new fee-for-service rates published under Massachusetts regulations 101 CMR 351.00. All AFC providers delivering services under Massachusetts Medicaid must use the updated rates for services rendered on or after the effective date.

Ohio SPA 25-0030 Approves Agency Name Change

CMS has approved Ohio State Plan Amendment (SPA) 25-0030, which amends Attachments 3.1-A and 4.19-B to reflect the administrative name change of the Ohio Department of Mental Health and Addiction Services (MHAS) to the Ohio Department of Behavioral Health (DBH). The amendment was approved on March 26, 2026, with an effective date of November 1, 2025.

Ohio Medicaid Alternative Benefit Plan Agency Name Change

The Centers for Medicare & Medicaid Services approved Ohio State Plan Amendment 25-0031, which updates the Alternative Benefit Plan to reflect an agency name change. The Ohio Department of Mental Health and Addiction Services has been renamed to the Ohio Department of Behavioral Health. The amendment was approved on March 26, 2026, with an effective date of November 1, 2025.

Hospital Drug Reimbursement Carve-Out Under Medicaid

CMS approved New York SPA 25-0064, effective October 1, 2025, which carves out select drugs provided in a hospital setting from inpatient payments and reimburses them separately under the state's Prescribed Drug methodology. The amendment affects Attachment 4.19-B pages 4(d)(1) and 4(d)(2) of New York's Medicaid State Plan.

NY Medicaid SPA 25-0053 - Inpatient Drug Reimbursement Carve-Out

CMS approved New York Medicaid State Plan Amendment 25-0053, which carves out select drugs administered in inpatient hospital settings from bundled inpatient payment rates for separate reimbursement. The amendment takes effect October 1, 2025. Affected drugs will be reimbursed per Attachment 4.19-B Prescribed Drugs sections. Providers are prohibited from using 340B inventory for carved-out drugs.

Rhode Island SPA 25-0013, Cell Gene Therapy reimbursement, hospitals, Acquisition Cost

Rhode Island SPA 25-0013, Cell Gene Therapy reimbursement, hospitals, Acquisition Cost

South Dakota Medicaid SUD/IMD Template and Provider List Updates

The Centers for Medicare & Medicaid Services (CMS) approved South Dakota's Medicaid State Plan Amendment (SPA) 25-0015. This amendment updates the Substance Use Disorders/Institutions for Mental Diseases template and revises the provider list for school-based direct services and administrative claiming.

Minnesota Medicaid SPA 25-0036: MAT Services Recovery Peers

The Centers for Medicare & Medicaid Services (CMS) approved Minnesota's State Plan Amendment (SPA) 25-0036, effective October 1, 2025. This amendment removes the end date for Medication Assisted Treatment (MAT) services and adds recovery peers and treatment coordinators as qualified providers.

Arizona Medicaid SPA AZ-25-0029 Updates Nursing Facility Rates

The Centers for Medicare & Medicaid Services (CMS) approved Arizona State Plan Amendment AZ-25-0029, updating fee-for-service payment rates for nursing facility services. These updated rates are effective January 1, 2026.

North Dakota Medicaid State Plan Amendment Approval

The Centers for Medicare & Medicaid Services (CMS) approved North Dakota's State Plan Amendment (SPA) 26-0008 on March 10, 2026. This amendment updates the designee responsible for State Plan submissions. The SPA was effective January 5, 2026.