The Centers for Medicare & Medicaid Services (CMS) Medicaid managed care regulations at 42 C.F.R. § 438 govern how states may direct plan expenditures in connection with implementing delivery system and provider payment initiatives under Medicaid managed care contracts. CMS began reviews of state directed payment arrangements beginning with contract rating periods on or after July 1, 2017. For more information on state directed payments, please visit our Guidance Page. Persons with disabilities having problems accessing the Preprint PDF files may call 410-786-0429 for assistance.
Approved State Directed Payment Preprints
Colorado
Uniform increase for professional services at an academic medical center for the rating period covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $11,331,455.
Approval Date:
October 30, 2026
Effective Date:
July 1, 2026
Links:
Missouri
Quality Payment/Pay for Performance (Category 2 APM, or similar) for inpatient and outpatient hospital services for the rating period covering July 1, 2025 through June 30,2026, incorporated into the capitation rates through a separate payment term in the amount of $233,573,938.
Approval Date:
October 27, 2026
Effective Date:
July 1, 2025
Links:
Pennsylvania
Uniform dollar amount for providers that provide private duty nursing to members under age 21 for the rating period covering January 1, 2027 through December 31, 2027, incorporated in the capitation rates through a risk-based rate adjustment up to $428,094.
Approval Date:
October 27, 2026
Effective Date:
January 1, 2027
Links:
Pennsylvania
Uniform percentage increase for dental services for the rating period covering January 1, 2027 through December 31, 2027, incorporated in the capitation rates through a risk-based rate adjustment up to $65,453,320.
Approval Date:
October 22, 2026
Effective Date:
January 1, 2027
Links:
Michigan
Uniform dollar increase for MI Choice direct care workers that provide home and community-based waiver services for the rating period covering October 1, 2026 through September 30, 2027, incorporated in the capitation rates through a risk-based rate adjustment up $68,100,000.
Approval Date:
October 19, 2026
Effective Date:
October 1, 2026
Links:
Virginia
The amendment to the uniform percentage increase for nursing facility-like services for individuals under age 21 for the rating period July 1, 2025, through June 30, 2026, incorporated in the capitation rates through a separate payment term amount up to $3,609,920.
Approval Date:
October 19, 2026
Effective Date:
July 1, 2025
Links:
South Carolina
Uniform increase established by the state for emergency medical transport services provided by ground non-governmental ambulance services providers for rating periods covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount of up to $14,412,730.
Approval Date:
October 16, 2026
Effective Date:
July 1, 2026
Links:
Arizona
Uniform increase for primary care, behavioral health outpatient, and justice involved clinic services for the rating period covering October 1, 2026 through September 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $41,000,000.
Approval Date:
October 9, 2026
Effective Date:
October 1, 2026
Links:
Pennsylvania
Minimum Fee Schedule for Integrated Community Wellness Centers for the rating period covering January 1, 2027 through December 31, 2027, incorporated in the capitation rates through a risk-based rate adjustment of up to $47,710,779.
Approval Date:
October 7, 2026
Effective Date:
January 1, 2027
Links:
West Virginia
The Uniform Increase for eligible Acute Care Hospitals established by the state for Specialty Physician Services for the rating period covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $47,949,316.
Approval Date:
October 6, 2026
Effective Date:
July 1, 2026
Links: