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
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 […]
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 […]
