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
Virginia
Uniform percentage increase for professional services at an academic medical center, primary care services, and specialty physician services for physicians employed by or contracted with an acute care hospital chain with a level one trauma center in the Tidewater Metropolitan Statistical Area (MSA) in 2020 for rating periods covering July 1, 2026 through June 30, 2027, incorporated in the capitation rates through a separate payment term amount up to $19,650,774.
Approval Date:
July 21, 2026
Effective Date:
July 1, 2026
Links:
Missouri
Uniform percentage increase for the professional services of designated providers affiliated with one of the qualifying hospitals for the rating period covering July 1, 2024 through June 30, 2025, incorporated into the capitation rates through a separate payment term up to $45,479,632.73.
Approval Date:
June 25, 2026
Effective Date:
July 1, 2024
Links:
Virginia
Uniform percentage increase for professional services at an academic medical center, primary care services, and specialty physician services 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 $7,885,485.
Approval Date:
June 18, 2026
Effective Date:
July 1, 2026
Links:
Virginia
Uniform percentage increase for professional services at an academic medical center, primary care services, and specialty physician services related to physicians employed by or contracted by a private acute care type 2 hospital system with at least one level 2 trauma center as of January 2022 located in Lord Fairfax Health District and Northwest Health Planning Region 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 $4,608,437.
Approval Date:
June 18, 2026
Effective Date:
July 1, 2026
Links:
Ohio
Uniform percentage increase for qualified practitioner services at an academic medical center, primary care and specialty physician services, and dental services, as well as 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 $23,716,304.
Approval Date:
June 12, 2026
Effective Date:
January 1, 2026
Links:
State Rating Period:
January 1, 2026
-
December 31, 2026
Payment Type:
Fee schedule
Value-based payment
Review Type:
Renewal
Approval Period:
Single Rating Period
Provider Class:
Dental services
Other
Primary care services
Professional services at an academic medical center
Specialty physician services
Indiana
Uniform increase for eligible physicians and non-physician practitioners for rating periods covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to $46,360,512.52.
Approval Date:
May 1, 2026
Effective Date:
January 1, 2026
Links:
Mississippi
Uniform dollar increase established by the state for inpatient hospital services, primary care services, and specialty physician services for the rating period covering July 1, 2025through June 30, 2026, incorporated into the capitation rates through a separate payment term amount of up to $6,603,083.
Approval Date:
April 23, 2026
Effective Date:
July 1, 2025
Links:
Michigan
Uniform increase established by the state for primary care and specialty physician services provided by practitioners employed or under contract with approved public entities, for the rating period covering October 1, 2025 through September 30, 2026, incorporated in the capitation rates through a separate payment term up to$610,000,000.
Approval Date:
March 27, 2026
Effective Date:
October 1, 2025
Links:
Arizona
Uniform percentage increase established by the state for Differential Adjusted Payments (DAP) program eligible providers for the rating period covering October 1, 2025 through September 30, 2026, and incorporated in the capitation rates through a risk based adjustment up to $150,850,000.
Approval Date:
March 26, 2026
Effective Date:
October 1, 2025
Links:
State Rating Period:
October 1, 2025
-
September 30, 2026
Payment Type:
Fee schedule
Review Type:
Amendment
Approval Period:
Single Rating Period
Provider Class:
Behavioral health inpatient service
Behavioral health outpatient services
Dental services
HCBS/personal care services
Inpatient hospital service
Nursing facility services
Outpatient hospital service
Primary care services
Specialty physician services
Florida
Uniform Dollar Increase for primary care services and nursing facility 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 $5,999,940.
Approval Date:
March 19, 2026
Effective Date:
October 1, 2024
Links: