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 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 These new pages superseded (i.e., replaced) full and partial pages that remain part of the State Plan Attachments. To indicate when a plan page contains superseded information, a red translucent overlay has been added.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 Number | Effective Date | SPA Topic | Disposition Date |
|---|---|---|---|
| 23-0001 (PDF) | 03/11/2021 | ARPA Treatment | 04/14/2023 |
| 23-0002 (PDF) | 03/01/2022 | ARPA HCBS-LTSS | 05/03/2023 |
| 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 |
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 |
| 22-0008 (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 |
| 22-0023 (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 |
| 22-0028 (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 |
| 21-0038 (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 |
2020 State Plan Amendments
| SPA Transmittal Number | Effective Date | SPA Topic | Disposition Date |
|---|---|---|---|
| 20-0001 (PDF) | 01/01/2020 | Physicians and Other Practitioners | 06/18/2020 |
| 20-0003 (PDF) | 09/01/2020 | HCBS-AMH Renewal | 08/31/2020 |
| 20-0005 (PDF) | 01/01/2020 | Clinical Diagnostic Laboratory | 06/17/2020 |
| 20-0006 (PDF) | 01/01/2020 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) | 06/22/2020 |
| 20-0007 (PDF) | 01/01/2020 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) | 06/26/2020 |
| 20-0010 (PDF) | 06/01/2020 | Value Based Rebate Agreement | 09/28/2020 |
| 20-0011 (PDF) | 03/18/2020 | Disaster COVID-19 | 10/23/2020 |
| 20-0012 (PDF) | 04/01/2020 | Disaster RAD COVID-19 | 08/21/2020 |
| 20-0013 (PDF) | 04/01/2020 | Disaster COVID-19 Rate Increases | 06/15/2020 |
| 20-0014 (PDF) | 09/01/2020 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) | 11/09/2020 |
| 20-0015 (PDF) | 04/01/2020 | Physicians | 08/24/2020 |
| 20-0016 (PDF) | 04/01/2020 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) | 08/24/2020 |
| 20-0017 (PDF) | 04/01/2020 | Family Planning | 08/24/2020 |
| 20-0018 (PDF) | 09/01/2020 | Rate Hearing Reform | 04/02/2021 |
| 20-0019 (PDF) | 09/01/2020 | Physicians Fees | 05/05/2021 |
| 20-0020 (PDF) | 09/01/2020 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) | 11/09/2020 |
| 20-0022 (PDF) | 09/01/2020 | Federally Qualified Health Center (FQHC) | 11/23/2020 |
2019 State Plan Amendments
| SPA Transmittal Number | Effective Date | SPA Topic | Disposition Date |
|---|---|---|---|
| 19-0001 (PDF) | 01/01/2019 | Physicians for Anesthesia Fees | 01/30/2019 |
| 19-0002 (PDF) | 01/01/2019 | Clinical Diagnostic Lab Fees | 04/17/2019 |
| 19-0003 (PDF) | 01/01/2019 | Chemical Dependency Treatment Facility (CDTF) | 04/17/2019 |
| 19-0004 (PDF) | 01/01/2019 | Physicians Fees | 04/18/2019 |
| 19-0005 (PDF) | 01/01/2019 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Fees | 04/18/2019 |
| 19-0006 (PDF) | 01/01/2019 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fees | 04/19/2019 |
| 19-0007 (PDF) | 03/01/2019 | Physicians Anesthesia Fees | 05/07/2019 |
| 19-0008 (PDF) | 03/01/2019 | Family Planning Fees | 04/22/2019 |
| 19-0009 (PDF) | 01/01/2019 | DAHS Cost Report Form | 06/24/2019 |
| 19-0010 (PDF) | 01/01/2019 | HCBS Cost Report Form | 06/24/2019 |
| 19-0011 (PDF) | 01/01/2019 | ICF/IDD Cost Projection Methodology | 05/13/2019 |
| 19-0012 (PDF) | 01/01/2019 | NF Cost Report Form | 06/03/2019 |
| 19-0013 (PDF) | 01/01/2019 | Primary Home Care Cost Report Form | 06/24/2019 |
| 19-0016 (PDF) | 04/01/2019 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fees | 07/17/2019 |
| 19-0017 (PDF) | 04/01/2019 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Fees | 07/18/2019 |
| 19-0018 (PDF) | 04/01/2019 | Physicians Fees | 07/19/2019 |
| 19-0022 (PDF) | 10/29/2019 | Clinical Diagnostic Lab Services | 10/19/2019 |
| 19-0023 (PDF) | 07/01/2019 | Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Fees | 10/09/2019 |
| 19-0024 (PDF) | 07/01/2019 | Physicians Fees | 10/10/2019 |
| 19-0026 (PDF) | 09/01/2019 | Inpatient Hospital | 12/11/2019 |
| 19-0027 (PDF) | 08/01/2019 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) | 10/18/2019 |
| 19-0028 (PDF) | 09/01/2019 | Private Duty Nursing | 11/04/2019 |
| 19-0029 (PDF) | 09/01/2019 | Personal Care Services | 11/07/2019 |
| 19-0030 (PDF) | 09/01/2019 | Physical, Occupational, and Speech Therapy Services | 11/05/2019 |
| 19-0031(PDF) | 07/13/2019 | ICF-IID Inflation Reversal | 10/30/2019 |
| 19-0032 (PDF) | 07/13/2019 | DAHS Attendant Minimum Wage | 11/06/2019 |
| 19-0033 (PDF) | 09/01/2019 | PHC Attendant Minimum Wage | 11/07/2019 |
| 19-0034 (PDF) | 09/01/2019 | CFC Attendant Minimum Wage | 11/13/2019 |
| 19-0035 (PDF) | 09/01/2019 | ICF Updates | 11/19/2019 |
| 19-0037 (PDF) | 11/01/2019 | Physicians and Other Practitioners | 01/30/2020 |
| 19-0038 (PDF) | 11/01/2019 | Chemical Dependency Treatment Facility (CDTF) | 02/03/2020 |
| 19-0039 (PDF) | 11/01/2019 | Early 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.
- 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 January 1, 2023)
- 04/05/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2020)
- 03/30/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective January 1, 2023)
- 03/28/2023 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective January 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 November 1, 2022)
- 08/26/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2022)
- 08/26/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2022)
- 07/29/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2022)
- 07/29/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2022)
- 07/29/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2022)
- 06/10/2022 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective August 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 February 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 January 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 January 1, 2022)
- 12/24/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective October 1, 2021)
- 12/24/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective December 1, 2021)
- 12/17/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective January 1, 2022)
- 12/17/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective October 1, 2021)
- 09/03/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 11, 2021)
- 09/03/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective October 1, 2021)
- 09/03/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective October 1, 2021)
- 08/27/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective February 1, 2022)
- 08/20/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2021)
- 08/06/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2021)
- 08/06/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2021)
- 08/06/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2021)
- 07/31/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2021)
- 07/30/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2021)
- 05/21/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2021)
- 03/26/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective October 1, 2020)
- 03/26/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective October 1, 2020)
- 02/19/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 1, 2021)
- 01/29/2021 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective February 1, 2021)
- 12/25/2020 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective January 1, 2021)
- 08/28/2020 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2020)
- 08/07/2020 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2020)
- 06/26/2020 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective September 1, 2020)
- 03/21/2020 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective April 1, 2020)
- 03/17/2020 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective March 18, 2020)
- 03/17/2020 PNI – Texas State Plan for Medical Assistance (PDF) – (Effective February 4, 2020)