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Medicaid State Plan and 1115 Waiver


The Medicaid State Plan is a document that serves as a contract between the State and the federal government that delineates Medicaid eligibility standards, provider requirements, payment methods, and health benefit packages. A Medicaid State Plan is submitted by each state and is approved by the Centers for Medicare and Medicaid Services (CMS). To make changes to the Medicaid State Plan, the state must submit a State Plan Amendment (SPA) to CMS for review and approval.

  • The RI Medicaid State Plan is not currently available in electronic format. To view the paper state plan, please contact: melody.lawrence@ohhs.ri.gov
  • See Proposed SPAs that are currently posted for public input.
  • Final approved versions of SPAs since 2010 can be found on the CMS website.
The Medicaid 1115 Waiver constitutes the legal authority granted to the State by federal government to pursue innovations that improve health care access, quality and outcomes and further the goals of the Medicaid and CHIP Programs.  The terms and conditions of the State’s Medicaid 1115 Waiver act as a contract that establishes the scope of the State’s flexibility under federal law relative to the Medicaid State Plan.   To make changes to the Medicaid 1115 Waiver, the State must submit a request to CMS for review and approval. 

COVID-19 Updates


In response to the Coronavirus Disease (COVID-19) pandemic, EOHHS has submitted requests to CMS to make necessary, temporary changes to the Medicaid program to ensure that Medicaid members continue to receive medically necessary Medicaid-covered services while minimizing exposure to the virus. The existing RI Comprehensive 1115 Demonstration Waiver (described above), will remain in force unless described in these emergency federal authority requests.  EOHHS does not intend to carry these authorities forward after the termination of the COVID-19 emergency declaration.

 

 Submitted to CMS March 16,2020

Submitted to CMS March 25,2020

 

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