An official State of Texas website.
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 October 15, 2024.
The electronic version of the Texas Medicaid State Plan Attachments pages contains 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 These new pages superseded (i.e., replaced) full and partial pages that remain part of the State Plan Attachments. To indicate when a plan page contains superseded information, a red translucent overlay has been added.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 2024 Texas State Medicaid Plan Approved by CMS
| SPA Transmittal Number | Effective Date | SPA Topic | Disposition Date |
|---|---|---|---|
| 24-0001 (PDF) | 01/01/2024 | Continuous Coverage for Children | 05/15/2024 |
| 24-0004 (PDF) | 02/01/2024 | Inpatient Psychiatric Services Accrediting Organizations | 08/09/2024 |
| 24-0005 (PDF) | 09/01/2024 | Prescribed Pediatric Extended Care Center (PPECC) | 05/14/2024 |
| 24-0007 (PDF) | 01/01/2024 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Rates | 03/28/2024 |
| 24-0009 (PDF) | 04/01/2024 | Emergency Response Services (ERS) | 06/12/2024 |
| 24-0011 (PDF) | 03/01/2024 | Physicians and other Practitioners’ Rates | 04/05/2024 |
| 24-0012 (PDF) | 03/01/2024 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Rates | 04/05/2024 |
| 24-0013 (PDF) | 03/01/2024 | Clinical Diagnostic Labs (CDL) Rates | 04/05/2024 |
| 24-0014 (PDF) | 03/01/2024 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Rates | 04/05/2024 |
| 24-0016 (PDF) | 04/01/2024 | Family Planning Rates | 05/08/2024 |
| 24-0018 (PDF) | 09/01/2025 | Temporary Non-preferred Drug Status | 08/29/2024 |
| 24-0022 (PDF) | 05/01/2024 | Physicians’ Rates | 08/27/2024 |
| 24-0023 (PDF) | 09/01/2024 | Clinical Diagnostic Labs (CDL) Rates | 10/07/2024 |
| 24-0024 (PDF) | 09/01/2024 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Rates | 10/07/2024 |
| 24-0025 (PDF) | 09/01/2024 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Rates | 10/07/2024 |
| 24-0026 (PDF) | 09/01/2024 | Physicians’ Rates | 10/07/2024 |
Amendments to the 2023 Texas State Medicaid Plan Approved by CMS
| SPA Transmittal Number | Effective Date | SPA Topic | Disposition Date |
|---|---|---|---|
| 23-0001 (PDF) | 03/11/2021 | American Rescue Plan Act (ARPA) Treatment | 04/14/2023 |
| 23-0002 (PDF) | 03/01/2022 | American Rescue Plan Act (ARPA) HCBS-LTSS | 05/03/2023 |
| 23-0004 (PDF) | 03/11/2021 | American Rescue Plan Act (ARPA) Vaccines | 02/23/2024 |
| 23-0005 (PDF) | 03/01/2023 | Physicians | 06/22/2023 |
| 23-0007 (PDF) | 03/01/2023 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) | 04/12/2023 |
| 23-0008 (PDF) | 03/01/2023 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) | 04/10/2023 |
| 23-0009 (PDF) | 01/01/2023 | Over the Counter - Vendor Drug Program (OTC-VDP) | 06/23/2023 |
| 23-0010 (PDF) | 03/01/2020 | Disaster Relief – Vendor Drug Program (DR-VDP) | 04/28/2023 |
| 23-0011 (PDF) | 04/01/2023 | Family Planning | 06/15/2023 |
| 23-0012 (PDF) | 04/01/2023 | Physicians | 06/29/2023 |
| 23-0013 (PDF) | 09/01/2023 | Attendant Wages Personal Care Services (PCS) | 10/26/2023 |
| 23-0014 (PDF) | 06/01/2023 | Nursing Facility Rate Increase | 07/28/2023 |
| 23-0015 (PDF) | 01/01/2023 | Former Foster Care Children | 01/25/2024 |
| 23-0016 (PDF) | 06/01/2023 | Community First Choice (CFC) Personal Assistance Services (PAS)/Habilitation (HAB) Consumer Directed Services (CDS) Rate | 09/13/2023 |
| 23-0017 (PDF) | 06/01/2023 | Prescribed Pediatric Extended Care Centers (PPECC) Rate | 09/13/2023 |
| 23-0018 (PDF) | 09/01/2023 | Attendant Wages CFC | 10/03/2023 |
| 23-0019 (PDF) | 09/01/2023 | Attendant Wages Day Activity and Health Services (DAHS) | 10/03/2023 |
| 23-0020 (PDF) | 09/01/2023 | Attendant Wages Intermediate Care Facilities (ICF) | 10/12/2023 |
| 23-0021 (PDF) | 09/01/2023 | Attendant Wages Primary Home Care (PHC) and Community Attendant Services (CAS) | 10/11/2023 |
| 23-0022 (PDF) | 06/01/2023 | Ambulatory Surgical Center (ASC) Reimbursement | 09/15/2023 |
| 23-0023 (PDF) | 09/01/2023 | Nursing Facility Rate Change | 10/12/2023 |
| 23-0024 (PDF) | 09/01/2023 | 1915i Home and Community Based Services (HCBS) Adult Mental Health (AMH) Attendant Wage Rate Increase | 09/15/2023 |
| 23-0027 (PDF) | 01/01/2024 | Personal Needs Allowance | 02/13/2024 |
| 23-0028 (PDF) | 03/01/2024 | Postpartum Continuous Coverage | 01/17/2024 |
| 23-0030 (PDF) | 07/01/2023 | Physicians and other Practitioners Rate | 09/22/2023 |
| 23-0031 (PDF) | 09/01/2023 | Pediatric Nursing Facility Rate | 10/13/2023 |
| 23-0033 (PDF) | 09/01/2023 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Fee Schedule | 10/03/2023 |
| 23-0034 (PDF) | 09/01/2023 | Ambulance Rates | 10/03/2023 |
| 23-0035 (PDF) | 09/01/2023 | Home Health Rates | 12/20/2023 |
| 23-0036 (PDF) | 09/01/2023 | Physicians’ and other Practitioners’ Rates | 10/03/2023 |
| 23-0037 (PDF) | 09/01/2023 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) | 10/04/2023 |
| 23-0038 (PDF) | 09/01/2023 | Rural Hospital Rates | 10/04/2023 |
| 23-0039 (PDF) | 07/01/2023 | End-stage Renal Disease Rate Changes | 12/12/2023 |
| 23-0040 (PDF) | 03/01/2024 | Drug Utilization Review Board | 03/07/2024 |
| 23-0043 (PDF) | 10/01/2023 | Physicians Rates | 01/18/2024 |
| 23-0045 (PDF) | 10/01/2023 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) | 01/18/2024 |
| 23-0046 (PDF) | 10/01/2023 | Disproportionate Share Hospitals | 07/18/2024 |
Archived State Plan Amendments
2022 State Plan Amendments
| SPA Transmittal Number | Effective Date | SPA Topic | Disposition Date |
|---|---|---|---|
| 22-0002 (PDF) | 01/01/2022 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) | 03/22/2022 |
| 22-0003 (PDF) | 01/01/2022 | Primary Home Care (PHC) | 03/23/2022 |
| 22-0005 (PDF) | 02/01/2022 | House Bill 4 Telemedicine and Telehealth | 05/03/2022 |
| 22-0006 (PDF) | 01/01/2022 | Qualified Clinical Trials | 05/09/2022 |
| 22-0007 (PDF) | 03/11/2021 | Vendor Drug Program Disaster SPA COVID | 02/15/2023 |
| 22-0008 (PDF) | 01/01/2022 | Physicians | 04/29/2022 |
| 22-0009 (PDF) | 03/01/2022 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) | 04/12/2022 |
| 22-0010 (PDF) | 03/01/2022 | Chemical Dependency Treatment Facility (CDTF) | 04/12/2022 |
| 22-0011 (PDF) | 03/01/2022 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) | 04/05/2022 |
| 22-0012 (PDF) | 08/24/2020 | VDP Disaster – COVID-19 | 02/15/2023 |
| 22-0013 (PDF) | 03/01/2022 | Inflation | 09/08/2022 |
| 22-0016 (PDF) | 03/01/2022 | Prescribed Pediatric Extended Care Centers (PPECC) | 04/29/2022 |
| 22-0019 (PDF) | 04/01/2022 | Family Planning | 06/22/2022 |
| 22-0021 (PDF) | 11/01/2022 | Local Intellectual and Developmental Disability Authorities (LIDDA) | 05/16/2023 |
| 22-0022 (PDF) | 06/01/2022 | Collaborative Care Model | 01/23/2024 |
| 22-0023 (PDF) | 09/01/2022 | Emergency Triage, Treat, and Transport (ET3) | 05/25/2023 |
| 22-0024 (PDF) | 06/01/2022 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) | 06/23/2022 |
| 22-0025 (PDF) | 06/01/2022 | Physicians and Other Practitioners | 06/22/2023 |
| 22-0026 (PDF) | 08/31/2022 | HCBS-AMH | 05/09/2023 |
| 22-0027 (PDF) | 09/01/2022 | Removes limitations on fee for service reimbursement for private providers of targeted case management | 10/03/2023 |
| 22-0028 (PDF) | 09/01/2022 | Financial Management Services Agency (FMSA) Rate | 03/01/2023 |
| 22-0033 (PDF) | 09/01/2022 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Vision | 11/09/2022 |
| 22-0034 (PDF) | 09/01/2022 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) | 10/06/2022 |
| 22-0035 (PDF) | 09/01/2022 | Medication Assisted Treatment (MAT) | 03/22/2023 |
| 22-0036 (PDF) | 09/01/2022 | Physicians | 06/22/2023 |
| 22-0038 (PDF) | 09/01/2022 | Ambulatory Surgical Centers (ASC) | 10/04/2022 |
2021 State Plan Amendments
| SPA Transmittal Number | Effective Date | SPA Topic | Disposition Date |
|---|---|---|---|
| 21-0001 (PDF) | 03/18/2020 | Disaster COVID-19 Physician Signature | 03/25/2021 |
| 21-0002 (PDF) | 02/01/2022 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) - Autism Services | 01/27/2022 |
| 21-0003 (PDF) | 06/01/2021 | Non-Emergency Medical Transportation (NEMT) | 05/25/2021 |
| 21-0004 (PDF) | 10/01/2020 | Medication-Assisted Treatment (MAT) | 03/17/2022 |
| 21-0008 (PDF) | 04/01/2020 | Disaster COVID-19 SHARS | 04/08/2021 |
| 21-0011 (PDF) | 09/01/2021 | Preadmission Screening and Resident Review (PASRR) | 11/01/2021 |
| 21-0012 (PDF) | 09/01/2021 | Potentially Preventable Readmissions (PPR) | 12/22/2021 |
| 21-0013 (PDF) | 03/01/2020 | COVID-19 Multiple Disaster Relief | 07/21/2021 |
| 21-0014 (PDF) | 03/01/2021 | Ambulatory Surgical Centers | 05/04/2021 |
| 21-0015 (PDF) | 03/01/2021 | Birthing Centers | 04/21/2021 |
| 21-0020 (PDF) | 01/01/2021 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) | 04/21/2021 |
| 21-0022 (PDF) | 01/01/2021 | Physicians and Other Practitioners | 05/05/2021 |
| 21-0023 (PDF) | 12/11/2020 | Federally Qualified Health Center (FQHC) Waiver Disaster | 04/19/2023 |
| 21-0024 (PDF) | 12/11/2020 | Rural Health Clinic Disaster | 04/19/2023 |
| 21-0025 (PDF) | 12/11/2020 | Nursing Facility Disaster Relief | 08/27/2021 |
| 21-0029 (PDF) | 03/20/2020 | Intermediate Care Facility Disaster Relief-Bed hold payments | 07/28/2021 |
| 21-0030 (PDF) | 03/20/2020 | 1915i Performance Measures Disaster Relief | 09/03/2021 |
| 21-0032 (PDF) | 09/01/2021 | Inpatient Hospital | 04/12/2022 |
| 21-0034 (PDF) | 09/01/2021 | Pediatric Nursing Facility | 12/22/2021 |
| 21-0036 (PDF) | 10/01/2021 | Private Hospital Augmented Reimbursement Program (HARP) | 08/15/2023 |
| 21-0038 (PDF) | 09/01/2021 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) | 12/06/2021 |
| 21-0040 (PDF) | 09/01/2021 | Home Health Fee Schedules | 11/08/2021 |
| 21-0041 (PDF) | 09/01/2021 | Physician Fee Schedules | 11/05/2021 |
| 21-0043 (PDF) | 10/01/2021 | Home Health Services | 03/16/2022 |
| 21-0044 (PDF) | 10/01/2021 | Ambulatory Surgical Centers Fee Schedule | 01/18/2022 |
| 21-0045 (PDF) | 10/01/2021 | Physicians and Other Practitioners | 01/18/2022 |
| 21-0048 (PDF) | 09/01/2021 | Medicaid Outpatient Reimbursement Rates for Rural Hospitals | 12/15/2021 |
| 21-0049 (PDF) | 10/01/2021 | Non-Emergency Medical Transportation (NEMT) | 02/03/2022 |
| 21-0053 (PDF) | 10/01/2021 | 1915i Performance Measures | 03/07/2022 |
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.
- 07/05/2024 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2025)
- 04/19/2024 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective May 1, 2024)1
- 04/16/2024 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2024)
- 03/22/2024 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective January 1, 2024)
- 03/08/2024 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective April 1, 2024)
- 02/16/2024 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2024)
- 02/09/2024 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2024)
- 01/26/2024 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective February 1, 2024)
- 12/15/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2024)
- 12/15/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Jan. 1, 2024)
- 10/13/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2024)
- 10/06/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective October 1, 2023)
- 09/08/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Oct. 1, 2023)
- 09/08/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Oct. 1, 2023)
- 08/18/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 08/11/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 08/11/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 08/11/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 08/11/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 08/11/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 08/04/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 07/21/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 07/21/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 07/21/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 07/21/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 07/07/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 07/07/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 06/30/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective July 1, 2023)
- 06/23/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective July 1, 2023)
- 06/09/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2023)
- 06/09/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective June 10, 2023)
- 05/27/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective June 1, 2022)
- 05/12/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective June 1, 2023)
- 05/12/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective June 1, 2023)
- 04/28/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective June 1, 2023)
- 04/14/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2020)
- 04/07/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Jan. 1, 2023)
- 04/05/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2020)
- 03/31/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 11, 2021)
- 03/30/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Jan. 1, 2023)
- 03/28/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Jan. 1, 2023)
- 03/10/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective April 1, 2023)
- 03/10/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective April 1, 2023)
- 03/03/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2022)
- 02/24/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2023)
- 02/24/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2023)
- 02/24/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2023)
- 02/03/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 11, 2021)
- 09/30/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Nov. 1, 2022)
- 09/16/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2022)
- 08/26/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2022)
- 08/26/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2022)
- 07/29/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2022)
- 07/29/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2022)
- 07/29/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Sept. 1, 2022)
- 06/10/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Aug. 31, 2022)
- 05/31/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective June 1, 2022)
- 04/29/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective June 1, 2022)
- 04/29/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective June 1, 2022)
- 03/25/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Feb. 1, 2022)
- 03/18/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective April 1, 2022)
- 02/25/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2022)
- 02/25/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Jan. 1, 2022)
- 02/18/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2022)
- 01/28/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2022)
- 01/07/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Jan. 1, 2022)
- 12/24/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Oct. 1, 2021)
- 12/24/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Dec. 1, 2021)
- 12/17/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Jan. 1, 2022)
- 12/17/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective Oct. 1, 2021)
1 The state plan amendment 24-0004 was initially assigned a different transmittal number (SPA 24-0003) as listed in the PNI.