State Plan

The Medicaid State Plan outlines the organization and function of the Alabama Medicaid Agency.  Amendments to the State Plan (SPAs) are required when changes to amount, duration or scope of services, or eligibility requirements are proposed.

Proposed State Plan Amendments

State Plan Documents
Entire State Plan  Bookmarked Document  -  Note: Large file may take a few minutes to download.
  Table of Contents
Section 1 Single State Agency Organization
Section 2 Coverage and Eligibility
Section 3 Services, General Provisions
Section 4 General Program Administration
Section 5 Personnel Administration
Section 6 Financial Administration
Section 7 General Provisions
1.1-A Attorney General's Certification
1.2-A Organization and Function of State Agency
1.2-B Organization and Functions of the Alabama Medicaid Agency
1.2-C Professional Medical Personnel and Supporting Staff
1.2-D Eligibility Determination Staff and Functions
2.1-A Definition of a Health Maintenance Organization
2.2-A Groups Covered and Agencies Responsible for Eligibility Determination
2.6-A Eligibility Conditions and Requirements
Supplemental 2.6-A Income Eligibility Levels
2.6-B Standards for Optional State Supplementary Payments
 3.1-A Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy
Supplement 1 of 3.1-A Targeted Case Management Services
Supplement 2 of 3.1-A Self-Directed Personal Assistance Services
Supplement 3 of 3.1-A Program of All Inclusive Care for the Elderly (PACE)
Supplement 4 of 3.1-A Medicated Assisted Treatment
3.1-B Amount, Duration, and Scope of Services Provided Medically Needy Group(s)
3.1-C Methods for Assuring High Quality of Care
3.1-D Methods for Providing Transportation
3.1-E Standards for the Coverage of Organ Transplant Services
3.1-F Managed Care
3.1-H Health Homes for Individuals with Chronic Conditions
3.2-A Coordination of Title XIX with Part A and Part B of Title XVIII
3.5-A Medicaid for Medicare Cost Sharing for Qualified Medicare Beneficiaries
4.11-A Standards for Medical Institutions
4.14-B Utilization Review in Intermediate Care Facilities
4.16-A Cooperative Agreements with Other Agencies
4.17-A Liens and Adjustments or Recoveries
4.18-A Service Charges for the Categorically Needy
4.18-D Premiums Imposed on Low Income Pregnant Women and Infants
4.18-E Optional Sliding Scale Premiums Imposed on Qualified Disabled and Working Individuals
4.19-A Method of Payment of Reasonable Costs for Inpatient Hospital Services

Payment for Medical Care and Services, Excluding Inpatient Hospital and Long Term Care Services

4.19-C Policy on Payment for Reserving Beds in an Inpatient Facility
4.19-D Methods and Procedures for Determining Nursing Facility Reimbursement
4.19-E Definition of a Claim
4.22-A Requirements for Third Party Liability - Identifying Liable Resources
4.22-B Third Party Collection Procedures to be Cost Effective
4.22-C State Method on Cost Effectiveness of Employer-Based Group Health Plans Private Health Insurance Buy In (PHIBI)
4.30 Sanctions for Psychiatric Hospitals
4.32-A Income and Eligibility Verification System Procedures Requests to Other State Agencies
4.33-A Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance
4.35-A-H Eligibility Conditions and Requirements - Enforcement of Compliance for Nursing Facilities
4.38-A Disclosure/Collection of Additional Registry Information
4.39-A Definition of Specialized Services/Categorical Determinations
4.40-A-E Eligibility Conditions and Requirements - Various
4.42-A Employee Education About False Claims Recoveries
4.43 Cooperation with Medicaid Integrity Program Efforts
7.2-A Statement of Compliance Certification for the Medical Assistance Program of Alabama
7.7-A Vaccine and Vaccine Administration at Section 1905(a)(4)(E) of the Social Security Act
7.7-B COVID-19 Testing at Section 1905(a)(4)(F) of the Social Security Act
7.7-C COVID-19 Treatment at Section 1905(a)(4)(F) of the Social Security Act