What is the Medicaid State Plan?

The State Plan is the officially recognized statement describing the nature and scope of Wisconsin's Medicaid program.

As required under Section 1902 of the Social Security Act (Act), the Plan was developed by our state and approved by the United States Department of Health & Human Services. The entity within the Department of Health and Human Services which reviews state plan documents is the Center for Medicare and Medicaid Services (CMS). Without a State Plan, Wisconsin would not be eligible for federal funding for providing Medicaid services. Essentially, the Plan is our state's agreement that it will conform to the requirements of the Act and the official issuances of CMS. The State Plan includes the many provisions required by the Act, such as:

• Methods of Administration
• Eligibility
• Services Covered
• Quality Control
• Fiscal Reimbursements.

Once the original Plan has been approved by CMS, all future changes to the Plan must also be approved by CMS before they can become effective. Plan changes are submitted by the state to CMS as State Plan Amendments. CMS reviews each State Plan Amendment to determine whether it meets federal requirements and policies. The Plan is updated when CMS issues final approval of a State Plan Amendment. A state can also ask CMS to waive certain federal requirements to allow it greater flexibility to institute such programs as primary care case management systems, and home and community-based services in lieu of institutionalization.

By law, a state's request to CMS to approve a proposed State Plan, a State Plan Amendment, or a waiver of a requirement, must be approved, disapproved, or additional information requested within 90 days of receipt. Otherwise, the request is considered to be approved.

The Plan on this website is for informational purposes only and is not legally binding. The official Plan is maintained by CMS Region V. The files on these pages are available as read-only in Word and in Portable Document Format (PDF), which requires the use of Adobe Acrobat Reader. The Adobe Acrobat Reader is necessary for the user to be able to read a PDF.