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Federal Requirements and State Options: How States Exercise Flexibility under a Medicaid State Plan

Federal law sets broad requirements for Medicaid and mandates coverage of some populations and benefits, while leaving others optional. Each state, however, has the responsibility of making the many policy and operational decisions that determine who is eligible for enrollment, which services are covered, and how payments to providers are established through its state plan. The state plan is a comprehensive document that must be approved by the Centers for Medicare & Medicaid Services, but can be amended as needed to reflect changes in state policy as well as federal law and regulation.

This publication examines state plan requirements and options across the following dimensions of the Medicaid program: appeals, benefits, delivery systems, eligibility standards, enrollment and renewal procedures, premium assistance, cost-sharing requirements, and provider payment policies.

Additional details on the federal requirements and state options are available in the following fact sheets: