1 Medicaid State Plan

Centers for Medicare & Medicaid Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
I2-Medicaid State Plan PRA document
Version 1.0
08/17/2017

Document Number: 192-QSSI-MACPro-PRA-I2-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. I2-Medicaid State Plan – Screenshots.................................................................... 1
1.1
1.2
1.3
1.4
1.5
1.6

Medicaid State Plan ........................................................................................ 1
Medicaid State Plan – Benefits and Payment – Path 1 ................................... 2
Medicaid State Plan – Benefits and Payment – Path 2 ................................... 2
Medicaid State Plan – Benefits and Payment – Path 3 ................................... 3
Medicaid State Plan – Benefits and Payment – Path 4 ................................... 3
Medicaid State Plan – Benefits and Payment – Path 5 ................................... 3

List of Figures
Figure 1: Medicaid State Plan – 1 ................................................................................... 1
Figure 2: Medicaid State Plan – 2 ................................................................................... 1
Figure 3: Medicaid State Plan – 3 ................................................................................... 2
Figure 4: Benefits and Payment – 1 ................................................................................ 2
Figure 5: Benefits and Payment – 2 ................................................................................ 2
Figure 6: Benefits and Payment – 3 ................................................................................ 3
Figure 7: Benefits and Payment – 4 ................................................................................ 3
Figure 8: Benefits and Payment – 5 ................................................................................ 3

I2-Medicaid State Plan PRA document Version 1.0

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CMS XLC

I2-Medicaid State Plan – Screenshots

1. I2-Medicaid State Plan – Screenshots
1.1

Medicaid State Plan

Figure 1: Medicaid State Plan – 1

Figure 2: Medicaid State Plan – 2

I2-Medicaid State Plan PRA document Version 1.0

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CMS XLC

I2-Medicaid State Plan – Screenshots

Figure 3: Medicaid State Plan – 3

1.2

Medicaid State Plan – Benefits and Payment – Path 1

Figure 4: Benefits and Payment – 1

1.3

Medicaid State Plan – Benefits and Payment – Path 2

Figure 5: Benefits and Payment – 2

I2-Medicaid State Plan PRA document Version 1.0

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CMS XLC

1.4

I2-Medicaid State Plan – Screenshots

Medicaid State Plan – Benefits and Payment – Path 3

Figure 6: Benefits and Payment – 3

1.5

Medicaid State Plan – Benefits and Payment – Path 4

Figure 7: Benefits and Payment – 4

1.6

Medicaid State Plan – Benefits and Payment – Path 5

Figure 8: Benefits and Payment – 5

I2-Medicaid State Plan PRA document Version 1.0

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