State Plan Amendment

A formal request submitted by a state to the Centers for Medicare and Medicaid Services (CMS) to modify the state's Medicaid program — adding services, changing eligibility, or altering payment structures. SPAs require CMS approval and must comply with federal Medicaid law. Oklahoma is pursuing a SPA to expand school-based health services to all Medicaid-eligible students, not just those with individualized education plans.

SPAs are a critical tool for making telehealth services permanently billable through Medicaid, transforming pilot programs funded by RHTP into sustainable, ongoing services. The RHTP explicitly requires states to develop sustainability plans, and SPAs are the most durable sustainability pathway — converting grant-funded telehealth into a billable Medicaid service.