Learn how Oregon administers its Medicaid and Children's Health Insurance Programs (CHIP) and requests changes from the Centers for Medicare and Medicaid Services (CMS).
Oregon's State Plans
Oregon posts its plans on this website for informational purposes only. They are not legally binding, will not contain any pending State Plan Amendment (SPA) information, and are only current relative to the date on the title page. The CMS Region 10 office in Seattle, Washington, maintains our official plans.
Proposed State Plan Amendments
When a state wants to change any of the Medicaid/CHIP benefits it offers or change the way in which services are offered, it must submit a State Plan Amendment. The following SPAs are currently at CMS review.
Frequently Asked Questions about State Plans
Q: What is a State Plan?
A: Under Section 1902 of the Social Security Act, all states must comply with some basic requirements. For example, each state must:
- Serve certain mandatory populations, such as poverty-level children and low-income pregnant women.
- Provide certain mandatory services, such as hospital care and physician services.
- Provide services that are "sufficient in amount, duration, and scope to reasonably achieve (their) purpose."
- Provide services throughout the state.
A State Plan outlines how each state will meet these requirements. Once CMS approves the original Plan, they must also approve all future changes to the Plan before any changes become effective. A state can also request CMS to waive certain federal requirements to allow greater flexibility or expand the Medicaid populations it serves. The CMS website provides more information about Medicaid and CHIP State Plans and Medicaid demonstration waivers.
Q: What is a State Plan Amendment?
A: When a state wants to change any of the Medicaid benefits it offers, or change the way in which services are offered, it must submit a State Plan Amendment (SPA).
Q: What happens when a state plan submits a State Plan Amendment to CMS?
A: Once the CMS Regional Office receives a SPA, it has 90 calendar days to approve or deny the SPA, or send a formal Request for Additional Information (RAI) letter. Once the CMS Regional Office receives a SPA, it has 90 calendar days to approve or deny the SPA, or send a formal Request for Additional Information (RAI) letter. Sending an RAI stops the 90-day clock. The clock will not start again until CMS receives the state's written response to the RAI. Another 90-day clock starts at this point. Throughout this process, CMS has the option of asking informal questions via e-mail or phone.
Q: When do State Plan Amendments become effective?
A: Once CMS approves a SPA, the changes can take effect retroactive to the first day of the quarter of the federal fiscal year in which the SPA was submitted. These procedures can make the SPA approval process quite lengthy.
Jesse Anderson, Policy Analyst