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
Michigan
Uniform increase established by the state for inpatient and outpatient hospital services for the rating period covering October 1, 2024 through September 30, 2025 incorporated into the capitation rates through a separate payment term up to $5,068,237,933.
Approval Date:
January 17, 2025
Effective Date:
October 1, 2024
Links:
State Rating Period:
October 1, 2024
-
September 30, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
North Carolina
Integrated Care for Kids (InCK) value based payment model for eligible primary care service providers for the rating periods covering July 1, 2023 through June 30, 2025, incorporated into the capitation rates through a risk based rate adjustment.
Approval Date:
January 17, 2025
Effective Date:
July 1, 2023
Links:
State Rating Period:
July 1, 2023
-
June 30, 2025
Payment Type:
Value-based payment
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Primary care services
North Carolina
Uniform percentage increase established by the state for inpatient and outpatient hospital services for the rating period covering July 1, 2025 through June 30, 2026, incorporated in the capitation rates through a separate payment term of up to $6,458,454,629.
Approval Date:
January 17, 2025
Effective Date:
July 1, 2025
Links:
State Rating Period:
July 1, 2025
-
June 30, 2026
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Behavioral health inpatient service
Behavioral health outpatient services
Inpatient hospital service
Outpatient hospital service
Ohio
Population-based payment established by the state for Mobile Response and Stabilization Services (MRSS) program providers for the rating period, January 1, 2025 through December 31, 2025, incorporated into the capitation rates through a separate payment term up to $36,650,413.
Approval Date:
January 17, 2025
Effective Date:
April 1, 2025
Links:
State Rating Period:
January 1, 2025
-
December 31, 2025
Payment Type:
Value-based payment
Review Type:
New
Approval Period:
Single Rating Period
Provider Class:
Behavioral health outpatient services
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, 2024 through June 30, 2025, incorporated in the capitation rates through a separate payment term of up to $40,347,612.
Approval Date:
January 16, 2025
Effective Date:
July 1, 2024
Links:
State Rating Period:
July 1, 2024
-
June 30, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Other
Arizona
Uniform dollar increase established by the state for nursing facility services for the rating period, October 1, 2024 through September 30, 2025, incorporated into the capitation rates through a separate payment term up to $92,400,000.
Approval Date:
January 15, 2025
Effective Date:
October 1, 2024
Links:
State Rating Period:
October 1, 2024
-
September 30, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Nursing facility services
California
Uniform increases established by the state for eligible Designated Public Hospital Systems for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $3,865,000,000.
Approval Date:
January 15, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 2025
-
December 31, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Nursing facility services
Outpatient hospital service
Primary care services
Professional services at an academic medical center
Specialty physician services
California
Uniform dollar increase established by the state for inpatient and outpatient hospital services at District Hospitals for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $842,391,000.
Approval Date:
January 15, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 2025
-
December 31, 2025
Payment Type:
Fee schedule
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Nursing facility services
Outpatient hospital service
California
Quality Incentive Pool for District and Municipal Public Hospital Systems for the rating period of January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $178,517,000.
Approval Date:
January 15, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 2025
-
December 31, 2025
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service
California
Quality Incentive Pool for Designated Public Hospital systems for the rating period of January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term of up to $3,463,690,000.
Approval Date:
January 15, 2025
Effective Date:
January 1, 2025
Links:
State Rating Period:
January 1, 2025
-
December 31, 2025
Payment Type:
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Inpatient hospital service
Outpatient hospital service