Texas Medicaid and CHIP
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 (HHS) as state plan amendments (SPAs). Through the Centers for Medicare and Medicaid Services (CMS), 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 Feb. 29, 2016 with the exception of Modified Adjusted Gross Income (MAGI) Eligibility State Plan Amendments.
The electronic version of the Texas Medicaid State Plan Attachments (SPA) pages contain 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 These new pages superseded (i.e., replaced) full and partial pages that remain part of the State Plan Attachments. To indicate when a plan page contains superseded information, a red translucent overlay has been added.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. Moussing 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.
- 15-026 (Outpatient Hospital Fees) - Effective Sept. 1, 2015 (PDF)
- 15-031 (Clinical Labs Fees) - Effective October 1, 2015 (PDF)
- 15-033 (Physician Fees) - Effective October 1, 2015 (PDF)
- 15-035 (State Plan Attachment Admin Correction) - Effective October 1, 2015 (PDF)
- 15-025 (Inpatient Hospital Fees) - Effective Sept. 1, 2015 (PDF)
- 15-034 (Physician Fees) - Effective Nov. 1, 2015 (PDF)
- 15-036 (Home Health Fees) - Effective Nov. 1, 2015 (PDF)
- 15-037 (Early and Periodic Screening, Diagnosis, and Treatment EPSDT Fees) - Effective Nov. 1, 2015 (PDF)
- 16-0002 (Federally Qualified Health Centers and Rural Health Clinics - FQHC Fees) - Effective Jan. 1, 2016 (PDF)