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 January 11, 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 These new pages superseded (i.e., replaced) full and partial pages that remain part of the State Plan Attachments. To indicate when a plan page contains superseded information, a red translucent overlay has been added.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 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
23-0013 (PDF)09/01/2023Attendant Wages Personal Care Services (PCS)10/26/2023
23-0014 (PDF)06/01/2023Nursing Facility Rate Increase07/28/2023
23-0016 (PDF)06/01/2023Community First Choice (CFC) Personal Assistance Services (PAS)/Habilitation (HAB) Consumer Directed Services (CDS) Rate09/13/2023
23-0017 (PDF)06/01/2023Prescribed Pediatric Extended Care Centers (PPECC) Rate09/13/2023
23-0018 (PDF)09/01/2023Attendant Wages CFC10/03/2023
23-0019 (PDF)09/01/2023Attendant Wages Day Activity and Health Services (DAHS)10/03/2023
23-0020 (PDF)09/01/2023Attendant Wages Intermediate Care Facilities (ICF)10/12/2023
23-0021 (PDF)09/01/2023Attendant Wages Primary Home Care (PHC) and Community Attendant Services (CAS)10/11/2023
23-0022 (PDF)06/01/2023Ambulatory Surgical Center (ASC) Reimbursement 09/15/2023
23-0023 (PDF)09/01/2023Nursing Facility Rate Change10/12/2023
23-0024 (PDF)09/01/20231915i Home and Community Based Services (HCBS) Adult Mental Health (AMH) attendant wage rate Increase09/15/2023
23-0030 (PDF)07/01/2023Physicians and other Practitioners Rate09/22/2023
23-0031 (PDF)09/01/2023Pediatric Nursing Facility Rate10/13/2023
23-0033 (PDF)09/01/2023Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) fee schedule10/03/2023
23-0034 (PDF)09/01/2023Ambulance Rates10/03/2023
23-0035 (PDF)09/01/2023Home Health Rates12/20/2023
23-0036 (PDF)09/01/2023Physicians’ and other Practitioners’ Rates10/03/2023
23-0037 (PDF)09/01/2023Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)10/04/2023
23-0038 (PDF)09/01/2023Rural Hospital Rates10/04/2023
23-0039 (PDF)07/01/2023End-stage Renal Disease Rate Changes12/12/2023

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
22-0027 (PDF)09/01/2022Removes limitations on fee for service reimbursement for private providers of targeted case management10/03/2023
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
21-0036 (PDF)10/01/2021Private Hospital Augmented Reimbursement Program (HARP)08/15/2023
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

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.