1932 State Plan Amendment Template (CMS-10120)

The State Medicaid Agencies will complete the template. CMS will review the information to determine if the state has met all the requirements under 1932(a)(1)(A) and 42 CFR 438.50. Once the all the requirements are met, the state will be allowed to enroll Medicaid beneficiaries on a mandatory basis into managed care entities without section 1115 or 1915(b) waiver authority.

The latest form for 1932 State Plan Amendment Template (CMS-10120) expires 2020-06-30 and can be found here.