Waivers

• Alabama
  • On April 30, Alabama received approval from CMS to extend its 1115 waiver, “Alabama Plan First.” With this extension approval, the state will continue to provide family planning and tobacco cessation services to eligible individuals for 12 months of continuous eligibility, limited to women ages 19 through 55 with income up to 141% of the federal poverty level (FPL) who are not otherwise eligible for Medicaid; and men age 21 or older with income up to 141% of the FPL who are not otherwise eligible for Medicaid. In accordance with State Medicaid Director Letters #10-013, #14-003, and #16-008, the agency has revised the state’s request and identified sexually transmitted infection and disease (STIs/STDs) screenings diagnosis services as family planning-related services in Alabama’s waiver. The demonstration is effective through September 30, 2030 (CMS.gov, April 30).
• Florida
  • On April 30, Florida received approval from CMS to extend its 1115 waiver, “Florida Medicaid Family Planning Waiver.” With this extension approval, Florida will continue to provide family planning services and family planning related services to women who are not otherwise enrolled in Medicaid or CHIP and meet other eligibility criteria. Eligibility for the demonstration is limited to 24 months, with a maximum of two 12-month continuous eligibility periods, after the loss of Medicaid coverage, subject to an annual redetermination. Individuals are eligible for the demonstration and a new 24-month coverage period upon each loss of Medicaid state plan eligibility. In accordance with State Medicaid Director Letters #10-013, #14-003, and #16-008, the agency has revised the state’s request and identified sexually transmitted infection and disease (STIs/STDs) screenings and diagnosis services as family planning-related services in Florida’s waiver. The demonstration is effective through June 30, 2030 (CMS.gov, April 30).
• Georgia
  • On April 30, the state received approval from CMS for its amendment to its 1115 waiver, “Planning for Healthy Babies.” In accordance with State Medicaid Director Letters #10-013, #14-003, and #16-008, the agency has revised the state’s request and identified sexually transmitted infection and disease (STIs/STDs) screenings as a family planning service and STI/STD diagnosis services as a family planning-related service in Georgia’s waiver. The demonstration is effective through December 31, 2029 (CMS.gov, April 30).
• Mississippi
  • On April 30, the state received approval from CMS for its amendment to its 1115 waiver, “Mississippi Family Planning.” In accordance with State Medicaid Director Letters #10-013, #14-003, and #16-008, the agency has revised the state’s request and identified sexually transmitted infection and disease (STIs/STDs) screenings as a family planning service and STI/STD diagnosis services as a family planning-related service in Mississippi’s waiver. The demonstration is effective through December 31, 2027 (CMS.gov, April 30).
• Montana
  • On April 30, the state received approval from CMS for its amendment to its 1115 waiver, “Montana Plan First.” In accordance with State Medicaid Director Letters #10-013, #14-003, and #16-008, the agency has revised the state’s request and identified sexually transmitted infection and disease (STIs/STDs) screenings as a family planning service and STI/STD diagnosis services as a family planning-related service in Montana’s waiver. The demonstration is effective through December 31, 2028 (CMS.gov, April 30).
• Oregon
  • On April 30, the state received approval from CMS for its amendment to its 1115 waiver, “Oregon Contraceptive Care.” In accordance with State Medicaid Director Letters #10-013, #14-003, and #16-008, the agency has revised the state’s request and identified sexually transmitted infection and disease (STIs/STDs) diagnosis services as a family planning-related service in Oregon’s waiver. The demonstration is effective through December 31, 2028 (CMS.gov, April 30).
• Washington
  • On April 30, Washington state received approval from CMS to extend its 1115 waiver, “Washington Family Planning Only Program.” This approval extends the demonstration, which offers a benefit package limited to family planning and family planning related services with 12 months of continuous eligibility and supplies, including contraception, counseling and education related to contraception, lab tests, and vasectomies to certain eligible individuals who are not otherwise enrolled in Medicaid or CHIP. In accordance with State Medicaid Director Letters #10-013, #14-003, and #16-008, the agency has revised the state’s request and identified sexually transmitted infection and disease (STIs/STDs) screenings and  diagnosis services as family planning-related services in Washington’s waiver. The demonstration is effective through June 30, 2030 (CMS.gov, April 30).
• Wyoming
  • On April 30, the state received approval from CMS for its amendment to its 1115 waiver, “Wyoming Pregnant By Choice.” In accordance with State Medicaid Director Letters #10-013, #14-003, and #16-008, the agency has revised the state’s request and identified sexually transmitted infection and disease (STIs/STDs) diagnosis services as a family planning-related service in Wyoming’s waiver. The demonstration is effective through December 31, 2027 (CMS.gov, April 30).

SPAs

• Payment SPAs
  • New Mexico (NM-25-0001, effective February 1, 2025): Increases the reimbursement rate for the Family Infant Toddler (FIT) program.
  • North Carolina (NC-25-0004, effective January 1, 2025): Establishes cost-based reimbursement methodology for select medications that are provided within professional outpatient and hospital inpatient or outpatient settings, such as cell and gene therapies.
• Service SPAs
  • Washington (WA-25-0001, effective July 1, 2025): Establishes Certified Peer Support Specialists and trainees as Rehabilitative Behavioral Health service providers.

Preprints

• Arizona (Effective October 1, 2024): Renews a uniform increase provided by the eligible public safety net hospital established by the state for inpatient and outpatient hospital services for the rating period covering October 1, 2024 through September 30, 2025, incorporated into the capitation rate through a separate payment term.
• Arizona (Effective October 1, 2024): Renews a uniform percentage increase established by the state for Differential Adjusted Payments (DAP) program eligible providers for the rating period covering October 1,2024 through September 30, 2025, and incorporated in the capitation rate through a risk-based adjustment.
• Massachusetts (Effective January 1, 2024): Renews a uniform increase established by the state for eligible inpatient and outpatient hospital services for the rating period covering January 1, 2024 through December 31, 2024, incorporated into the capitation rates through a separate payment term.