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
New Jersey
Uniform dollar increase for inpatient and outpatient hospital services provided by Middlesex County hospitals for the rating period, July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term up to$534,141,249.
Approval Date:
March 19, 2026
Effective Date:
July 1, 2025
Links:
New Jersey
Uniform dollar increase for inpatient and outpatient hospital services provided by Mercer County hospitals for the rating period, July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term up to $185,883,506.
Approval Date:
March 19, 2026
Effective Date:
July 1, 2025
Links:
New Jersey
The amendment of the uniform increase for inpatient hospital services provided by Middlesex County hospitals for the rating period covering July 1, 2023 through June 30, 2024, incorporated in the capitation rates through a separate payment term up to$187,423,005.
Approval Date:
March 19, 2026
Effective Date:
July 1, 2023
Links:
Pennsylvania
Quality Payment/Pay for Performance (Category 2 APM, or similar) and Performance Improvement Initiative for nursing facility services for rating periods covering January1, 2024 through December 31, 2024, incorporated in the capitation rates through a separate payment term amount of up to $15,000,000.
Approval Date:
March 18, 2026
Effective Date:
January 1, 2024
Links:
Pennsylvania
Uniform percentage increase for inpatient hospital and outpatient hospital services for rating periods covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to $2,335,007,317.
Approval Date:
March 18, 2026
Effective Date:
January 1, 2026
Links:
Pennsylvania
Uniform percentage increase for inpatient hospital and outpatient hospital services for rating periods covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to $424,720,803.
Approval Date:
March 18, 2026
Effective Date:
January 1, 2026
Links:
Illinois
Uniform increase for critical access hospitals established by the state for outpatient hospital services for the rating period, January 1, 2026 through December 31, 2026,incorporated into the capitation rates through a separate payment term up to $13,500,000.
Approval Date:
March 17, 2026
Effective Date:
January 1, 2026
Links:
Missouri
Minimum and maximum fee schedule for inpatient and outpatient hospital services for children’s hospitals for the rating period covering July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a risk-based adjustment.
Approval Date:
March 17, 2026
Effective Date:
July 1, 2025
Links:
Missouri
Minimum and maximum fee schedules established by the state for outpatient hospital services for the rating period covering July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a risk-based adjustment.
Approval Date:
March 17, 2026
Effective Date:
July 1, 2025
Links:
Missouri
Minimum and maximum fee schedules established by the state for inpatient hospital services for the rating period covering July 1, 2025 through June 30, 2026, incorporated into the capitation rates through a risk-based adjustment.
Approval Date:
March 17, 2026
Effective Date:
July 1, 2025
Links: