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
Inpatient Hospital Payment Index: Comparison Across States
September 24, 2026
In 2017, MACPAC published an issue brief that presented an inpatient hospital payment index comparing Medicaid inpatient hospital fee-for-service payment across states and to Medicare. Staff presented our work to update the inpatient hospital index to utilize new data sources from 2022 and include managed care spending.
MACPAC discussed the assumptions and adjustments made to calculate […]
State Medicaid Payment Policies for Medicare Cost Sharing
August 25, 2025
A new compendium and related Policy in Brief from MACPAC provides state-level information on Medicare crossover policies for inpatient hospital services, outpatient hospital services, nursing facility services, and physician services as of May 2025. It finds that most states have lesser of policies, with slight variation across service types.
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 […]