Provider Payment
States may offer Medicaid benefits on a fee-for-service (FFS) basis, through managed care plans, or both. Under the FFS model, the state pays providers directly for each covered service received by a Medicaid enrollee. Under managed care, the state pays a fee to a managed care plan for each person enrolled in the plan. In turn, the plan pays providers for all of the Medicaid services an enrollee may require that are included in the plan’s contract with the state. Learn more about how Medicaid programs pay providers and structure the delivery of care.
For a summary of major Medicaid payment policy developments, click here.
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Click here to watch Medicaid 101: Disproportionate Share Hospitals
Learn More about These Topics
- Disproportionate share hospital payments
- Supplemental payments
- Medicaid managed care payment
- Managed care
- Value-based payment
- Provider payment under fee for service
- Managed care rate setting
Featured Publications
Evaluating the Effects of Medicaid Payment Changes on Access to Physician Services
January 7, 2025
Physicians often cite low Medicaid reimbursement rates as the primary reason for not accepting new Medicaid patients. However, research connecting Medicaid payment rates to access remains limited.
To further investigate this relationship, MACPAC partnered with Mathematica to conduct a literature review and host a roundtable with experts from federal agencies and academia. The discussion focused on […]
Directed Payments in Medicaid Managed Care
October 31, 2024
In 2016, the Centers for Medicare & Medicaid Services (CMS) updated the regulations for Medicaid managed care and created a new option called directed payments for states, allowing them to direct managed care organizations (MCOs) to pay providers according to specific rates or methods. Since their initial implementation, directed payment arrangements have grown rapidly in […]
Directed Payments in Medicaid Managed Care
October 29, 2024
In 2016, the Centers for Medicare & Medicaid Services (CMS) updated the regulations for Medicaid managed care and created a new option for states, allowing them to direct managed care organizations (MCOs) to pay providers according to specific rates or methods. These directed payment arrangements can be used to establish minimum or maximum fee schedules […]
