State Plan

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:

  1. Click on the Bookmark tab to the left of the plan pages to see a detailed index.
  2. 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 July 17, 2023.

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 These new pages superseded (i.e., replaced) full and partial pages that remain part of the State Plan Attachments. To indicate when a plan page contains superseded information, a red translucent overlay has been added.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 2023 Texas State Medicaid Plan Approved by CMS

SPA Transmittal NumberEffective DateSPA TopicDisposition Date
23-0001 (PDF)03/11/2021ARPA Treatment04/14/2023
23-0002 (PDF)03/01/2022ARPA HCBS-LTSS05/03/2023
23-0005 (PDF)03/01/2023Physicians06/22/2023
23-0007 (PDF)03/01/2023Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)04/12/2023
23-0008 (PDF)03/01/2023Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)04/10/2023
23-0009 (PDF)01/01/2023Over the counter - Vendor Drug Program (OTC-VDP)06/23/2023
23-0010 (PDF)03/01/2020Disaster relief – Vendor Drug Program (DR-VDP)04/28/2023
23-0011 (PDF)04/01/2023Family Planning06/15/2023
23-0012 (PDF)04/01/2023Physicians06/29/2023

Archived State Plan Amendments

2022 State Plan Amendments

SPA Transmittal NumberEffective DateSPA TopicDisposition Date
22-0002 (PDF)01/01/2022Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)03/22/2022
22-0003 (PDF)01/01/2022Primary Home Care (PHC)03/23/2022
22-0005 (PDF)02/01/2022House Bill 4 Telemedicine and Telehealth05/03/2022
22-0006 (PDF)01/01/2022Qualified Clinical Trials05/09/2022
22-0008 (PDF)01/01/2022Physicians04/29/2022
22-0009 (PDF)03/01/2022Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)04/12/2022
22-0010 (PDF)03/01/2022Chemical Dependency Treatment Facility (CDTF)04/12/2022
22-0011 (PDF)03/01/2022Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)04/05/2022
22-0012 (PDF)08/24/2020VDP Disaster – COVID-1902/15/2023
22-0013 (PDF)03/01/2022Inflation09/08/2022
22-0016 (PDF)03/01/2022Prescribed Pediatric Extended Care Centers (PPECC)04/29/2022
22-0019 (PDF)04/01/2022Family Planning06/22/2022
22-0021 (PDF)11/01/2022Local Intellectual and Developmental Disability Authorities (LIDDA)05/16/2023
22-0023 (PDF)09/01/2022Emergency Triage, Treat, and Transport (ET3)05/25/2023
22-0024 (PDF)06/01/2022Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)06/23/2022
22-0025 (PDF)06/01/2022Physicians and Other Practitioners06/22/2023
22-0026 (PDF)08/31/2022HCBS-AMH05/09/2023
22-0028 (PDF)09/01/2022Financial Management Services Agency (FMSA) Rate03/01/2023
22-0033 (PDF)09/01/2022Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Vision11/09/2022
22-0034 (PDF)09/01/2022Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)10/06/2022
22-0035 (PDF)09/01/2022Medication Assisted Treatment (MAT)03/22/2023
22-0036 (PDF)09/01/2022Physicians06/22/2023
22-0038 (PDF)09/01/2022Ambulatory Surgical Centers (ASC)10/04/2022

2021 State Plan Amendments

SPA Transmittal NumberEffective DateSPA TopicDisposition Date
21-0001 (PDF)03/18/2020Disaster COVID-19 Physician Signature03/25/2021
21-0002 (PDF)02/01/2022Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) - Autism Services01/27/2022
21-0003 (PDF)06/01/2021Non-Emergency Medical Transportation (NEMT)05/25/2021
21-0004 (PDF)10/01/2020Medication-Assisted Treatment (MAT)03/17/2022
21-0008 (PDF)04/01/2020Disaster COVID-19 SHARS04/08/2021
21-0011 (PDF)09/01/2021Preadmission Screening and Resident Review (PASRR)11/01/2021
21-0012 (PDF)09/01/2021Potentially Preventable Readmissions (PPR)12/22/2021
21-0013 (PDF)03/01/2020COVID-19 Multiple Disaster Relief07/21/2021
21-0014 (PDF)03/01/2021Ambulatory Surgical Centers05/04/2021
21-0015 (PDF)03/01/2021Birthing Centers04/21/2021
21-0020 (PDF)01/01/2021Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)04/21/2021
21-0022 (PDF)01/01/2021Physicians and Other Practitioners05/05/2021
21-0023 (PDF)12/11/2020Federally Qualified Health Center (FQHC) Waiver Disaster04/19/2023
21-0024 (PDF)12/11/2020Rural Health Clinic Disaster04/19/2023
21-0025 (PDF)12/11/2020Nursing Facility Disaster Relief08/27/2021
21-0029 (PDF)03/20/2020Intermediate Care Facility Disaster Relief-Bed hold payments07/28/2021
21-0030 (PDF)03/20/20201915i Performance Measures Disaster Relief09/03/2021
21-0032 (PDF)09/01/2021Inpatient Hospital04/12/2022
21-0034 (PDF)09/01/2021Pediatric Nursing Facility12/22/2021
21-0038 (PDF)09/01/2021Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)12/06/2021
21-0040 (PDF)09/01/2021Home Health fee schedules11/08/2021
21-0041 (PDF)09/01/2021Physician fee schedules11/05/2021
21-0043 (PDF)10/01/2021Home Health Services03/16/2022
21-0044 (PDF)10/01/2021Ambulatory Surgical Centers fee schedule01/18/2022
21-0045 (PDF)10/01/2021Physicians and other practitioners01/18/2022
21-0048 (PDF)09/01/2021Medicaid outpatient reimbursement rates for rural hospitals12/15/2021
21-0049 (PDF)10/01/2021Non-Emergency Medical Transportation (NEMT)02/03/2022
21-0053 (PDF)10/01/20211915i Performance Measures03/07/2022

2020 State Plan Amendments

SPA Transmittal NumberEffective DateSPA TopicDisposition Date
20-0001 (PDF)01/01/2020Physicians and Other Practitioners06/18/2020
20-0003 (PDF)09/01/2020HCBS-AMH Renewal08/31/2020
20-0005 (PDF)01/01/2020Clinical Diagnostic Laboratory06/17/2020
20-0006 (PDF)01/01/2020Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)06/22/2020
20-0007 (PDF)01/01/2020Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)06/26/2020
20-0010 (PDF)06/01/2020Value Based Rebate Agreement09/28/2020
20-0011 (PDF)03/18/2020Disaster COVID-1910/23/2020
20-0012 (PDF)04/01/2020Disaster RAD COVID-1908/21/2020
20-0013 (PDF)04/01/2020Disaster COVID-19 Rate Increases06/15/2020
20-0014 (PDF)09/01/2020Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)11/09/2020
20-0015 (PDF)04/01/2020Physicians08/24/2020
20-0016 (PDF)04/01/2020Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)08/24/2020
20-0017 (PDF)04/01/2020Family Planning08/24/2020
20-0018 (PDF)09/01/2020Rate Hearing Reform04/02/2021
20-0019 (PDF)09/01/2020Physicians Fees05/05/2021
20-0020 (PDF)09/01/2020Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)11/09/2020
20-0022 (PDF)09/01/2020Federally Qualified Health Center (FQHC)11/23/2020

2019 State Plan Amendments

SPA Transmittal NumberEffective DateSPA TopicDisposition Date
19-0001 (PDF)01/01/2019Physicians for Anesthesia Fees01/30/2019
19-0002 (PDF)01/01/2019Clinical Diagnostic Lab Fees04/17/2019
19-0003 (PDF)01/01/2019Chemical Dependency Treatment Facility (CDTF)04/17/2019
19-0004 (PDF)01/01/2019Physicians Fees04/18/2019
19-0005 (PDF)01/01/2019Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Fees04/18/2019
19-0006 (PDF)01/01/2019Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fees04/19/2019
19-0007 (PDF)03/01/2019Physicians Anesthesia Fees05/07/2019
19-0008 (PDF)03/01/2019Family Planning Fees04/22/2019
19-0009 (PDF)01/01/2019DAHS Cost Report Form06/24/2019
19-0010 (PDF)01/01/2019HCBS Cost Report Form06/24/2019
19-0011 (PDF)01/01/2019ICF/IDD Cost Projection Methodology05/13/2019
19-0012 (PDF)01/01/2019NF Cost Report Form06/03/2019
19-0013 (PDF)01/01/2019Primary Home Care Cost Report Form06/24/2019
19-0016 (PDF)04/01/2019Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fees07/17/2019
19-0017 (PDF)04/01/2019Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Fees07/18/2019
19-0018 (PDF)04/01/2019Physicians Fees07/19/2019
19-0022 (PDF)10/29/2019Clinical Diagnostic Lab Services10/19/2019
19-0023 (PDF)07/01/2019Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Fees10/09/2019
19-0024 (PDF)07/01/2019Physicians Fees10/10/2019
19-0026 (PDF)09/01/2019Inpatient Hospital12/11/2019
19-0027 (PDF)08/01/2019Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)10/18/2019
19-0028 (PDF)09/01/2019Private Duty Nursing11/04/2019
19-0029 (PDF)09/01/2019Personal Care Services11/07/2019
19-0030 (PDF)09/01/2019Physical, Occupational, and Speech Therapy Services11/05/2019
19-0031(PDF)07/13/2019ICF-IID Inflation Reversal10/30/2019
19-0032 (PDF)07/13/2019DAHS Attendant Minimum Wage11/06/2019
19-0033 (PDF)09/01/2019PHC Attendant Minimum Wage11/07/2019
19-0034 (PDF)09/01/2019CFC Attendant Minimum Wage11/13/2019
19-0035 (PDF)09/01/2019ICF Updates11/19/2019
19-0037 (PDF)11/01/2019Physicians and Other Practitioners01/30/2020
19-0038 (PDF)11/01/2019Chemical Dependency Treatment Facility (CDTF)02/03/2020
19-0039 (PDF)11/01/2019Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)02/04/2020

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.