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
Florida
Uniform percentage increase for inpatient and outpatient hospital services for rating periods covering October 1, 2024 through January 31, 2025, incorporated in the capitation rates through a separate payment term amount up to $108,835,976.
Approval Date:
February 20, 2026
Effective Date:
October 1, 2024
Links:
Ohio
Uniform percentage increase for qualified practitioner services at an academic medical center and a value-based performance payment to providers who attain quality performance target(s), starting July 1, 2025 for the rating period covering January 1, 2025through December 31, 2025, incorporated into capitation rates through a separate payment term of up to $41,019,224.
Approval Date:
February 18, 2026
Effective Date:
July 1, 2025
Links:
New Jersey
Uniform percentage increase for professional services provided by qualified providers employed or contracted with the AtlantiCare health system which is affiliated with Stockton University’s nursing and allied health training programs for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term up to $50,611,881.
Approval Date:
February 18, 2026
Effective Date:
July 1, 2025
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), starting July 1, 2025 for the rating period covering January 1, 2025 through December 31, 2025, incorporated into capitation rates via a separate payment term up to$73,626,919.
Approval Date:
February 18, 2026
Effective Date:
July 1, 2025
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), starting July 1, 2025 for the rating period covering January 1, 2025 through December 31, 2025, incorporated into capitation rates via a separate payment term up to$11,644,644.
Approval Date:
February 18, 2026
Effective Date:
July 1, 2025
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), starting July 1, 2025 for the rating period covering January 1, 2025 through December 31, 2025, incorporated into capitation rates via a separate payment term up to$7,678,571.
Approval Date:
February 18, 2026
Effective Date:
July 1, 2025
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), starting July 1, 2025 for the rating period covering January 1, 2025 through December 31, 2025, incorporated into capitation rates via a separate payment term up to$125,000,000.
Approval Date:
February 18, 2026
Effective Date:
July 1, 2025
Links:
Hawaii
Pay for performance arrangement established by the state for public and private hospitals as defined in the preprint for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term up to $103.5 million; Uniform dollar increase established by the state for safety net hospitals owned and operated by a government agency for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term up to $78.47 million; Uniform percentage increase established by the state for inpatient and outpatient hospital services within privately-owned hospital provider classes for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term up to $241.69 million; and, Minimum and Maximum Fee Schedule established by the state for in-state general acute hospitals and children’s hospital services within in-state general acute hospital provider classes for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
February 12, 2026
Effective Date:
January 1, 2026
Links:
Washington
Uniform percentage increase established by the state for behavioral health outpatient services for Medicaid-enrolled managed care enrollees delivered by PACT teams(Program of Assertive Community Treatment) 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 $3,000,000.
Approval Date:
February 12, 2026
Effective Date:
January 1, 2026
Links:
New Mexico
Renewal of the uniform dollar increase for inpatient and outpatient hospital services and performance-based quality payments established by the state for the State Teaching Hospital that provides guaranteed access to care for Native Americans for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term up to $310 million.
Approval Date:
February 10, 2026
Effective Date:
January 1, 2026
Links: