(a) Format. A State plan for Medicaid consists of a standardized template, issued and updated by CMS, that includes both basic requirements and individualized content that reflects the characteristics of the State's program. The Secretary will periodically update the template and format specifications for State plans and plan amendments through a process consistent with the requirements of the Paperwork Reduction Act.
(b) Governor's review—(1) Basic rules. Except as provided in paragraph (b)(2) of this section—
(i) The Medicaid agency must submit the State plan and State plan amendments to the State Governor or his designee for review and comment before submitting them to the CMS regional office.
(ii) The plan must provide that the Governor will be given a specific period of time to review State plan amendments, long-range program planning projections, and other periodic reports on the Medicaid program, excluding periodic statistical, budget and fiscal reports.
(iii) Any comments from the Governor must be submitted to CMS with the plan or plan amendment.
(2) Exceptions. (i) Submission is not required if the Governor's designee is the head of the Medicaid agency.
(ii) Governor's review is not required for preprinted plan amendments that are developed by CMS if they provide absolutely no options for the State.
(c) Plan amendments. (1) The plan must provide that it will be amended whenever necessary to reflect—
(i) Changes in Federal law, regulations, policy interpretations, or court decisions; or
(ii) Material changes in State law, organization, or policy, or in the State's operation of the Medicaid program. For changes related to advance directive requirements, amendments must be submitted as soon as possible, but no later than 60 days from the effective date of the change to State law concerning advance directives.
(2) Prompt submittal of amendments is necessary—
(i) So that CMS can determine whether the plan continues to meet the requirements for approval; and
(ii) To ensure the availability of FFP in accordance with § 430.20.
[53 FR 36571, Sept. 21, 1988, as amended at 60 FR 33293, June 27, 1995; 81 FR 86447, Nov. 30, 2016]
Notes of Decisions
Nat'l Fed'n of Indep. Bus. v. Sebelius, 132 S. Ct. 2566 (2012).
· cites it 3× “See 42 CFR §430.12 (c)(i) (2011). And from 1965 to the present, States have regularly conformed to Congress’ alterations of the Medicaid Act.”
Stewart v. Azar, 313 F. Supp. 3d 237 (D.C. Cir. 2018).
· cites it 3× “; see *244 also 42 C.F.R. § 430.12 (c). Currently, all states have chosen to participate in the program.”
The Arc of California v. Toby Douglas, 757 F.3d 975 (9th Cir. 2014).
· cites it 2× “See 42 C.F.R. § 430.12 (c). The Medicaid Act authorizes the Secretary to waive certain of the Act’s otherwise-applicable requirements by granting a so-called home- and community-based services (“HCBS”) waiver.”
New Jersey Primary Care Ass'n v. New Jersey Dep't of Human Servs., 722 F.3d 527 (3rd Cir. 2013).
· cites it 3× “§ 1396a and 42 C.F.R. § 430.12 (c), and (b) failing to provide FQHCs with full and timely wraparound payments; (2) violated New Jersey regulations implementing Medicaid; and (3) violated the FQHCs’ right to procedural due process by depriving them of wraparound payments without…”
State of Tenn. v. United States Dep't of State, 931 F.3d 499 (6th Cir. 2019).
“42 C.F.R. § 430.12 . Once the plan is approved, the state receives reimbursement from the federal government for a percentage of the costs of providing care to eligible individuals: the "Federal Medical Assistance Percentage" ("FMAP").”
Cmty. Health Care Ass'n v. Shah, 770 F.3d 129 (2d Cir. 2014).
· cites it 2× “See 42 C.F.R. § 430.12 (c). Section 1396a(bb) was scheduled to be implemented for “services furnished on or after January 1, 2001,” 42 U.”
Medina v. Planned Parenthood South Atl., 606 U.S. 357 (2025).
“§1396c; see also 42 CFR §430.12 (c) (2023). In practice, how- ever, HHS rarely invokes its authority to withhold funding because doing so would inevitably harm the program’s ben- eficiaries.”
Planned Parenthood v. Joshua Baker, 941 F.3d 687 (4th Cir. 2019).
“§§ 1316 (a), 1396c; 42 C.F.R. § 430.12 ; (2) a state administrative process for providers to challenge termination decisions, 42 U.”
Maxwell Kadel v. Dale Folwell, 100 F.4th 122 (4th Cir. 2024).
“” 42 C.F.R. § 430.12 (a). For “categorically needy” populations, 10 states must cover certain basic categories of services and may cover other optional categories of services.”
— 42 C.F.R. § 430.12(c)(2) — 2 cases
— 42 C.F.R. § 430.12(c)(2)(i) — 1 case
Annotations are extracted automatically from the opinions in the
Syfert caselaw corpus and ranked by authority, recency, and
treatment. Dots show Syfertize treatment of the citing case itself.