RI Medicaid Program: State Plan Amendments and Section 1115 Waiver Demonstration Category Changes
The RI Medicaid State Plan (MSP) and the State’s Medicaid Section 1115 waiver demonstration provide the legal authority required under federal law to operate the Medicaid program;
- The MSP 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).
- The RI Section 1115 waiver constitutes the legal authority granted to the State by the Secretary of the U.S. Department of Health and Human Services. The Section 1115 waiver provides the State with the flexibility 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 Section 1115 waiver act as a contract that establishes the scope of the State’s flexibility under federal law relative to the MSP.
Should the State makes changes to the Medicaid program that affect eligibility, the amount, duration, or scope of services; payment methodoligies; or delivery systems alterations must be made to the MSP and/or the Section 1115 waiver in accordance with procedures established under federal law. State Plan Amednments alter the MSP while Category Changes update the Section 1115 waiver. The two change documents operate in similar manners.
Recent MSP and Section 1115 waiver amendments are available below: