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 Hampshire
Uniform dollar increase for qualified behavioral health outpatient services established by the state 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 $2,650,000.
Approval Date:
May 28, 2026
Effective Date:
July 1, 2026
Links:
Ohio
Uniform percentage increase for inpatient and outpatient hospital services, and a value-based performance payment to providers who attain quality performance target(s), for the rating period covering January 1, 2026 through December 31, 2026, incorporated into capitation rates via a separate payment term up to $171,549,902.
Approval Date:
May 28, 2026
Effective Date:
January 1, 2026
Links:
Virginia
Minimum Fee Schedule for Durable Medical Equipment providers for the rating period covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a risk-based rate adjustment up to $0.
Approval Date:
May 28, 2026
Effective Date:
July 1, 2026
Links:
Virginia
Uniform percentage increase for inpatient hospital and outpatient hospital services for rating periods covering July 1, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term amount up to $4,612,626,679.
Approval Date:
May 22, 2026
Effective Date:
July 1, 2024
Links:
Massachusetts
Performance improvement initiative for community behavioral health center services for the rating period covering January 1, 2025 through December 31, 2027, incorporated in the capitation rates through a separate payment term amount up to $51,000,000 ($17,000,000 per year).
Approval Date:
May 21, 2026
Effective Date:
January 1, 2025
Links:
Florida
Uniform percentage increase for professional services at an academic medical center for the rating period covering October 1, 2024 through January 31, 2025, incorporated in the capitation rates through a separate payment term amount of up to $130,462,908.
Approval Date:
May 21, 2026
Effective Date:
October 1, 2024
Links:
Florida
Uniform percentage increase for professional services at an academic medical center for the rating period covering February 1, 2025 through September 30, 2025, incorporated in the capitation rates through a separate payment term amount of up to $260,925,815.
Approval Date:
May 21, 2026
Effective Date:
February 1, 2025
Links:
Nebraska
Uniform increase for non-state owned or operated hospitals established by the state for inpatient and 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 $1,410,710,373.
Approval Date:
May 20, 2026
Effective Date:
January 1, 2026
Links:
Rhode Island
The Total Cost of Care payment arrangement for the state’s Accountable Entities, as authorized in the state’s section 1115 demonstration for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a risk-based rate adjustment of up to $109,000,000.
Approval Date:
May 20, 2026
Effective Date:
July 1, 2025
Links:
Washington
Uniform increase established by the state for publicly funded sexual and reproductive health family planning providers as designated by the Department of Health for the rating period covering January 1, 2026, through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment up to $2,100,000.
Approval Date:
May 20, 2026
Effective Date:
January 1, 2026
Links: