Payment and Delivery Systems

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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Featured publications

Report to Congress on Medicaid Disproportionate Share Hospital Payments

February 2016 |

The Protecting Access to Medicare Act of 2014 required MACPAC to produce annual reports on Medicaid disproportionate share hospital (DSH) payment, specifically to analyze how state allotments relate to three factors: (1) changes in the number of uninsured individuals, (2) amounts and sources of hospitals’ uncompensated care costs, and (3) the number of hospitals with […]