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Structure of the State Plan

Medicaid was created by the Social Security Amendments of 1965, which added Title 19 to the Social Security Act. The State Plan originated with that legislation.

The initial pages of the State Plan are referred to as the "text pages". These are pre-printed forms created by the federal agency that administers Medicaid - now named the Centers for Medicare & Medicaid Services (CMS). From the text pages one looks to the attachments for further detail. Still further detail appears in the supplements.

The table of contents of the plan breaks the material into seven broad categories. For those who interact with the State Plan on a daily basis, much of this material is rarely consulted.

Pages of the State Plan include footers showing when that page was created. Often someone who is unfamiliar with the plan asks for the "current version" of a section of the plan, finding that the footer shows that the page was created some time ago. However, pages are inserted and remain valid until superseded by a page which is subsequently adopted by an amendment approved by CMS. As one is leafing through the state plan, one travels back and forth through time as some pages have been recently updated while others have been in place for decades.

Of the seven sections of the State Plan, four of them are rarely consulted. Sections 1, 5, 6, and 7 address (respectively) single state agency organization, personnel administration, financial administration, and general provisions. Within the remaining three sections, there is additional material that is infrequently consulted. A list of "frequently used sections" provides links to the sections that come into play on a day to day basis - standards for eligibility, covered services, and standards for reimbursement of providers.

In 2014, CMS began amending portions of the State Plan outside of the traditional amendment process. As a result, certain portions of the State Plan no longer fall within the traditional seven State Plan sections. Instead, these portions are separately submitted to CMS electronically with references in the traditional State Plan sections as appropriate. These new portions are attached to the traditional State Plan in the Electronic Submissions section following the Attachments and Supplements.

With these directions, we hope that the Medicaid State Plan becomes more user-friendly, while maintaining the integrity of its structure, which reflects the administration of a program which is nearly 50 years of age.

Last revised March 22, 2022