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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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
Medicaid Base and Supplemental Payments to Hospitals
May 8, 2024
States make different types of Medicaid payments to hospitals and have broad flexibility to design their own payment methods. The two broad categories of payments are (1) base payments for services and (2) supplemental payments, which are typically made in a lump sum for a fixed period of time. States vary in the mix of […]
Update on Hospital Supplemental Payment Analyses
April 10, 2024
During the September 2023 public meeting, the Commission discussed a long-term work plan for examining all types of Medicaid payments to hospitals, including disproportionate share hospital (DSH) payments, non-DSH supplemental payments, and managed care directed payments. This session provided an overview on staff findings from a preliminary review of supplemental payment targeting methods and the […]
Annual Analysis of Medicaid Disproportionate Share Hospital Allotments to States
March 15, 2024
Chapter 3 continues the Commission’s work on its annual report on Medicaid disproportionate share hospital (DSH) allotments to states. As in prior years, the Commission continues to find little meaningful relationship between state DSH allotments and the number of uninsured individuals; the amounts and sources of hospitals’ uncompensated care costs; and the number of hospitals […]