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.
Click here for our Medicaid 101 series on YouTube.
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
Themes from Hospital Payment Index Technical Expert Panel
September 19, 2024
In 2017, MACPAC constructed a state-level hospital payment index to compare fee-for-service (FFS) inpatient hospital payments across states and to Medicare payment rates. To update the payment index, we convened a Technical Expert Panel (TEP) with representatives from federal and state government, hospitals, consultants, and researchers. The purpose of the TEP was to discuss ways […]
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 targeting […]
