Recent State Plan Amendments (SPAs)

The following attachments are amendments to the West Virginia State Medicaid Plan that were recently approved by the Centers of Medicare and Medicaid Services (CMS). To update your copy of the State Medicaid Plan, please follow the Page Replacement Instructions.

SPA 24-0012 Mandatory Core Set Reporting for Adult and Child Core Sets (Approved November 14, 2024, Effective December 31, 2024)
SPA 24-0002 Coverage Limit for Dental Services for Adults Aged 21 and Older for Diagnostic, Preventative, and Restorative Services, Excluding Cosmetic Services. (Approved October 29, 2024, Effective July 1, 2024)
SPA 24-0007-A Statewide Bipolar and at Risk of Hepatitis B and C to terminate the West Virginia Health Homes Program Statewide (Approved October 8, 2024, Effective July 1, 2024)
SPA 24-0011-M Statewide Bipolar and at Risk of Hepatitis B and C to comply with mandatory reporting of the Health Home Core Set measures (Approved October 8, 2024, Effective July 1, 2024)
SPA 24-0010-M Pre-Diabetes, Diabetes, Obesity, at Risk for Anxiety and/or Depression (Approved October 8, 2024, Effective July 1, 2024)
SPA 24-0005 -A Pre-Diabetes, Diabetes, Obesity, at Risk for Anxiety and/or Depression to terminate the Health Homes Program (Approved October 4, 2024, Effective July 1, 2024)
SPA 23-0010   Adult Vaccine Coverage and Administration (Approved February 26, 2024, Effective October 1, 2023)
SPA 23-0003 Medicaid Community-Based Mobile Crisis Intervention Services Coverage (Approved September 5, 2023, Effective July 1, 2023)
SPA 23-0009 Over-the-Counter Coverage (Approved June 22, 2023, Effective January 1, 2023)
SPA 23-0008 Former Foster Care Children Eligibility Group (Approved May 19, 2023, Effective January 1, 2023)
SPA 23-0005 Personal Care Program Training Requirements (Approved June 16, 2023, Effective January 1, 2023)
SPA 22-0006 Medicaid Disaster Relief for the COVID-19 National Emergency (Approved May 3, 2023, Effective July 1, 2022)
SPA 22-0004   Medicaid Disaster Relief for the COVID-19 National Emergency (Approved April 28, 2023, Effective March 1, 2020)
SPA 22-0015 Vaccine Administration (Approved March 24, 2023, Effective March 11, 2021)
SPA 22-0016 Rescind Temporary Policies, Medicaid Disaster Relief for the National Emergency (Approved September 14, 2022, Effective May 1, 2022)
SPA 22-0011 Targeted Case Management Rate Increase (Approved September 16, 2022, Effective April 1, 2022)
SPA 22-0010 Behavioral Health Rate Increase (Approved September 16, 2022, Effective April 1, 2022)
SPA 22-0009 Personal Care Rate Increase (Approved September 16, 2022, Effective April 1, 2022)
SPA 22-0008 Health Insurance Premium Payment Program (Approved October 4, 2022, Effective January 1, 2022)
SPA 22-0007 Postpartum Coverage Extension (Approved September 8, 2022, Effective April 1, 2022)
SPA 22-0022 Ambulance Ground Transportation Increased to 100 percent. (Approved November 9, 2022, Effective July 1, 2022)
SPA 22-0012 90-Day Prescriptions Refill (Approved September 21, 2022, Effective the Day After Public Health Emergency ends)
SPA 22-0003 Drug Free Moms and Babies (Approved September 6, 2022, Effective June 9, 2022)
SPA 22-0018 Diagnosed Related Group Days Awaiting Placement or Discharge Approved September 13, 2022, Effective June 1, 2022
SPA 22-0020 Third-Party Liability Approved July 11, 2022, Effective April 1, 2022
SPA 22-0004 Durable Medical Equipment Approved May 31, 2022, Effective January 12, 2022
SPA 22-0006 Medicaid Disaster Relief State Plan for COVID-19 National Emergency Approved May 6, 2022, Effective April 1, 2021
SPA 22-0005 Recovery Audit Contractor Approved April 27, 2022, Effective January 1, 2022
SPA 22-0001       Transportation Services Approved March 23, 2022, Effective January 1, 2022
SPA 22-0002 Coverage for Clinical Trials Approved March 23, 2022, Effective January 1, 2022
SPA 21-0011          Medicaid Disaster Relief for COVID-19 National Emergency Approved October 13, 2021, Effective August 1, 2021
SPA 21-0002 Mandatory Medicaid State Plan Coverage of Medication-Assisted Treatment Approved October 7, 2021, Effective October 1, 2021
SPA 21-0010 Medicaid Disaster Relief for the COVID-19 National Emergency Approved August 27, 2021, Effective June 1, 2020
SPA 21-0008-A       Alternative Benefit Plan Approved July 21, 2021, Effective January 1, 2021
SPA 21-0001          Clinic Services and Adult Dental Services Approved May 28, 2021, Effective January 1, 2021
SPA 21-003             Medicaid Recovery Audit Contractor Program Approved May 19, 2021, Effective January 1, 2021
SPA 21-005             Medicaid Disaster Relief for the COVID-19 National Emergency Approved May 7, 2021, Effective December 1, 2020
SPA 21-0007           Medicaid Disaster Relief for the COVID-19 National Emergency Approved December 17, 2020, Effective July 1, 2020
SPA 20-0006           Medicaid Disaster Relief for the COVID-19 National Emergency Approved December 17, 2020, Effective March 1, 2020
SPA 20-0004           Medicaid Disaster Relief for the COVID-19 National Emergency Approved August 13, 2020, Effective March 1, 2020
SPA 20-0001           Chiropractic Services Approved September 17, 2020,  Effective April 1, 2020
SPA-19-0006 West Virginia Children's Insurance Program Approved October 11, 2019, Effective July 1, 2019
SPA-19-0005 Medicaid Drug Utilization Review Approved  March 23, 2020, Effective October 1, 2019
SPA 19-002 Physical Therapy and Occupational Therapy Approved September 25, 2019, Effective July 1, 2019
SPA 19-0004 Income Eligibility for Pregnant Women Approved August 3, 2019, Effective July 1, 2019
SPA 18-005   Ambulance Reimbursement  Approved December 17, 2018, Effective January 1, 2019
SPA 17-002 Recovery Audit Contractor (RAC) Approved February 8, 2018, Effective October 1, 2017
SPA 17-004 Neonatal Abstinence Syndrome Treatment Services Approved February 8, 2018, Effective October 31, 2017
SPA 17-0005 Elimination of Enhanced Payments Approved January 22, 2018, Effective October 1, 2017
SPA 17-0003 Inpatient Hospital Services Approved January 19, 2018, Effective October 1, 2017
SPA 16-0006 Special Hospital Payments, Data Source Approved November 8, 2016, Effective July 1, 2016

Archived Approved Amendments