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What is the State Plan?

The State Plan is the officially recognized statement describing the nature and scope of Washington State's Medicaid Program.

Who developed and approved the State Plan?

The Plan was developed by our state and approved by the United States Department of Health & Human Services (DHHS), as required under Section 1902 of the Social Security Act (Act).

Why is a State Plan necessary?

A State Plan is required to qualify for federal funding for providing Medicaid services. Essentially, the Plan is our state's agreement that it will conform to the requirements of the Act and the official issuances of DHHS.

What is included in the State Plan?

The State Plan includes many provisions required by the Act, such as:

  • Methods of administration
  • Eligibility
  • Services covered
  • Quality control
  • Fiscal reimbursements

What happens after a State Plan is approved?

Once the original Plan has been approved by DHHS, all future changes to the Plan must also be approved by DHHS before they can become effective.

Can changes be made to the State Plan?

Yes. Plan changes can be submitted by the state to DHHS and are known as State Plan Amendments (SPAs). DHHS, through the Centers for Medicare and Medicaid Services (CMS), reviews each SPA to determine whether it meets federal requirements and policies. The Plan is updated when CMS issues final approval of a SPA.

A state can also ask DHHS to waive certain federal requirements to allow it greater flexibility to institute such programs as primary care case management systems, and home and community-based services in lieu of institutionalization.

How long does a State Plan Amendment take to be approved?

By law, a state's request to DHHS to approve a proposed State Plan, a SPA, or a waiver of a requirement, must be approved, disapproved, or additional information requested within 90 days of receipt. Otherwise, the request is considered to be approved.

The Plan on this website is for informational purposes only and is not legally binding. The official Plan is maintained by CMS Region X.