New York State Medicaid State Plan

What is the Medicaid State Plan?

A Medicaid State Plan is an official document that describes the nature and scope of a state´s Medicaid program. Each state develops its own Plan, as required under Section 1902 of the Social Security Act (Act), which is then approved by the federal Department of Health & Human Services (DHHS). Any changes or amendments to the Plan are similarly developed by the state and approved by DHHS. Each state administers its own Plan and, in doing so, agrees to conform to the requirements of the Act and all other applicable federal statutes and regulations related to the Medicaid program.

The Plan dictates the policies and procedures that a state will follow in administering the Medicaid program, including those related to the methods of administration, eligibility criteria, covered services, and reimbursement methodologies, to name a few.

In most cases, a state is required to issue a Public Notice prior to the effective date of any change to the Plan. The Public Notice, which appears in the New York State, Department of State´s State Register, is intended to inform providers, stakeholders, and the general public of substantial proposed changes to the State´s Medicaid Plan, as well as to offer the opportunity to comment on such changes.

This portion of the Department of Health´s website will provide New York´s Medicaid State Plan, presented in its entirety and in sections, which is updated no less frequently than quarterly. In addition, the site will provide proposed State Plan Amendments (SPAs) as of January 1, 2011, along with the approval status.

NYS Medicaid State Plan

The most current and approved Medicaid State Plan is available as one PDF document.

Please Note: If you choose to download the most current Medicaid State Plan in its entirety, it is a very large PDF file approximately 103 MB.

Portal/Disaster SPAs note: SPAs submitted through the CMS MMDL and MACPro Portals, such as eligibility, Health Homes, cost sharing, and MAGI are not compatible with the current State Plan document. Therefore, these SPAs are listed under Section 8, with links to the SPAs. Also, please note that the Disaster SPAs are located under Section 7.4

The proposed State Plan Amendments are not final and are subject to further revisions which may not be reflected on this website prior to final approval and inclusion in the State Plan.