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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- Provider payment under fee for service
- Disproportionate share hospital payments
- Supplemental payments
- Managed care
- Medicaid managed care payment
- Managed care rate setting
- Value-based payment
Featured publications
Value-Based Payment for Maternity Care in Medicaid: Findings from Five States
Some states are using value-based payment (VBP) models as a way to improve the maternity care for Medicaid beneficiaries. States have implemented a number of different models, including perinatal episodes of care, pay for performance, and pregnancy medical homes. This brief provides background on VBP models and describes how five states (Arkansas, Connecticut, Colorado, North […]
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Arkansas Perinatal Episode of Care
Arkansas established the perinatal episode of care model under its Arkansas Health Care Payment Improvement Initiative in 2012. The goal of the perinatal episode was to encourage patient-centered care throughout pregnancy, reduce variation in the cost and quality of pregnancy care, and increase provider accountability for improving the quality and efficiency of perinatal care. Arkansas […]
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Connecticut Pay for Performance in Obstetrics Care Program
Connecticut Medicaid established the pay for performance in obstetrics care program in 2013. The goals of the model are to improve overall care of pregnant women, newborn outcomes, and the incidence of avoidable mortality and morbidity. Under the model, obstetrical providers participating in Medicaid are eligible for bonus payments if they meet certain quality and […]
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