Medicaid State Plan And 1115 Waiver

The Medicaid State Plan is a document that serves as a contract between the State and the federal government that delineates Medicaid eligibility standards, provider requirements, payment methods, and health benefit packages. A Medicaid State Plan is submitted by each state and is approved by the Centers for Medicare and Medicaid Services (CMS). To make changes to the Medicaid State Plan, the state must submit a State Plan Amendment (SPA) to CMS for review and approval.

• The RI Medicaid State Plan is not currently available in electronic format. To view the paper state plan, please contact: Kathryn.Thomas@ohhs.ri.gov or visit here for a scanned PDF version.
• See Proposed SPAs that are currently posted for public input.
• Final approved versions of SPAs since 2010 can be found on the CMS website.

The Medicaid 1115 Waiver constitutes the legal authority granted to the State by federal government to pursue innovations that improve health care access, quality and outcomes and further the goals of the Medicaid and CHIP Programs.  The terms and conditions of the State’s Medicaid 1115 Waiver act as a contract that establishes the scope of the State’s flexibility under federal law relative to the Medicaid State Plan.   To make changes to the Medicaid 1115 Waiver, the State must submit a request to CMS for review and approval. Any proposed amendments can be viewed at the following link: Proposed Waiver Amendments.

Annual Demonstration Waiver Public Forum

EOHHS is holding a Public Forum on the topic of Rhode Island’s current 1115 Demonstration Waiver. The purpose of this annual Forum is to afford the public an opportunity to provide meaningful comment on the progress of the Demonstration. Please note that this refers to the Demonstration Waiver that is currently in effect, not to the process of renewing the state’s Demonstration Waiver.

The Annual Demonstration Monitoring Report for the 2023 calendar year, submitted to the Centers for Medicare and Medicaid Services, is available here.

Date: Monday, November 18

Time: 9am to 10am

Location:

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• Current Medicaid 1115 Waiver: Section 1115 Demonstration Special Terms and Conditions Approved 3/21/2024
• Final Interim Evaluation Report on Current Medicaid 1115 Waiver
• For former 1115 Waivers, past extension application materials and background documents, and EOHHS Taskforce meetings see Archive.

COVID-19 Updates

In response to the Coronavirus Disease (COVID-19) pandemic, EOHHS has submitted requests to CMS to make necessary, temporary changes to the Medicaid program to ensure that Medicaid members continue to receive medically necessary Medicaid-covered services while minimizing exposure to the virus. The existing RI Comprehensive 1115 Demonstration Waiver (described above), will remain in force unless described in these emergency federal authority requests.  EOHHS does not intend to carry these authorities forward after the termination of the COVID-19 emergency declaration.

Summary of Emergency COVID-19 Federal Authorities as of  9.18.20

COVID-19 Telehealth Policies

• COVID-19 EOHHS-OHIC Telehealth Preventive Care Guidance (Updated May 7, 2020)
• COVID-19 Coverage for Testing and ESCL Guidance   

  Submitted to CMS March 16,2020

• Public Notice of COVID Section 1135 Waiver Request
• Public Notice of COVID 1115 Waiver Request
• Public Notice of COVID Emergency Disaster Relief CHIP SPA
• Public Notice of COVID Emergency Disaster Relief SPA Second Notice
• COVID Section 1135 Waiver Request to CMS 
• COVID 1115 Waiver Request to CMS 
• COVID Emergency Disaster Relief CHIP SPA Request to CMS

Submitted to CMS March 25,2020

• Public Notice of COVID Section 1135 Waiver Request
• Public Notice of COVID 1115 Waiver Amendment Request
• Public Notice of COVID Disaster Relief SPA
• COVID Section 1135 Waiver Request to CMS
• COVID 1115 Waiver Amendment Request to CMS
• Appendix K Request to CMS
• COVID Disaster Relief SPA Request to CMS

 Submitted to CMS April 7,2020

• Notice to Public Disaster Relief SPA 4/7/20
• Disaster Relief SPA with Nursing Home Rate Increases
• Appendix K Version 3

Submitted to CMS April 8,2020

• Notice to Public 1135 COVID Waiver Request
• 1135 COVID Waiver Request
• Notice to Public COVID 1115 Homelessness Waiver Request
• COVID 1115 Homelessness Waiver Request
• Notice to Public COVID IMD 1115 Waiver
• COVID IMD 1115 Waiver Request

Submitted to CMS May 4, 2020

• Public Notice Medicaid Disaster Relief Emergency Case Management SPA
• Medicaid Disaster Relief Emergency Case Management SPA
• Public Notice 1135 HCBS Waiver Request
• 1135 HCBS Waiver Request

 Submitted to CMS May 12, 2020

• Appendix K Retainer

Submitted to CMS January 14, 2021

• Extension of Appendix K Authorities Request to CMS

Submitted to CMS January 21, 2021

• Notice to Public Disaster Relief SPA for Experimental/Investigational Vaccines and Treatments for COVID-19
• Disaster Relief SPA for Experimental/Investigational Vaccines and Treatments for COVID-19

Submitted to CMS February 9, 2021

• 1135 COVID Waiver Request for Fair Hearings

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