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
Nevada
Uniform dollar amount for inpatient hospital and outpatient hospital services for the rating period covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term amount up to $1,290,268,866.
Approval Date:
February 6, 2026
Effective Date:
January 1, 2025
Links:
Kentucky
Uniform dollar increase for eligible government-owned or operated ground ambulance services for rating periods covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to$32,564,448.
Approval Date:
February 5, 2026
Effective Date:
January 1, 2026
Links:
Kentucky
Uniform dollar increase for eligible emergency ground ambulance provider services for rating periods covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to $64,003,052.
Approval Date:
February 5, 2026
Effective Date:
January 1, 2026
Links:
Nevada
Uniform percentage increase for inpatient hospital and outpatient hospital services for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to $197,169,083.
Approval Date:
February 5, 2026
Effective Date:
January 1, 2026
Links:
Delaware
Uniform increase for inpatient and outpatient hospital services and behavioral health inpatient and outpatient services for rating periods covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount of up to $309,503,881.
Approval Date:
February 4, 2026
Effective Date:
January 1, 2026
Links:
Delaware
Uniform increase for inpatient and outpatient hospital services and behavioral health inpatient and outpatient services for rating periods covering January 1, 2025 through December 31, 2025, incorporated in the capitation rates through a separate payment term amount up to $309,503,881.
Approval Date:
February 4, 2026
Effective Date:
January 1, 2025
Links:
Hawaii
Pay for performance arrangement established by the state for public and private nursing facilities as defined in the preprint for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term up to $2.8 million; and, Uniform dollar increase established by the state for nursing facility services within government-owned nursing facilities for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a separate payment term amount up to $17.86 million.
Approval Date:
February 4, 2026
Effective Date:
January 1, 2026
Links:
Massachusetts
Minimum Fee Schedule for behavioral health outpatient services including 24 hour diversionary substance use disorder services and behavioral health diversionary services for the rating period covering January 1, 2026 through December 31, 2026, incorporated in the capitation rates through a risk-based rate adjustment.
Approval Date:
February 4, 2026
Effective Date:
January 1, 2026
Links:
Michigan
Uniform increase established by the state for inpatient and outpatient hospital services for the rating period covering October 1, 2025 through September 30, 2026, incorporated into the capitation rates through a separate payment term up to $4,873,315,610.
Approval Date:
February 4, 2026
Effective Date:
October 1, 2025
Links:
Georgia
Uniform percentage increase for professional services at an academic medical center established by the state for the rating period covering July 1, 2025 through June 30,2026, incorporated in the capitation rates through a separate payment term of up to$239,351,323.31.
Approval Date:
February 3, 2026
Effective Date:
July 1, 2025
Links: