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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Featured publications

Annual Analysis of Disproportionate Share Hospital Allotments to States

March 2018 |

Chapter 3 contains MACPAC’s statutorily required annual analysis of disproportionate share hospital (DSH) payment policy. In this year’s analysis, we continue to find no meaningful relationship between states’ DSH allotments and the three factors that Congress has asked the Commission to study: the number of uninsured individuals; the amounts and sources of hospitals’ uncompensated care […]

Comparing Medicaid Hospital Payment Across States and to Medicare

September 2016 |

This presentation summarizes MACPAC’s work to date on a new state-level payment index that will compare states’ Medicaid fee-for-service inpatient hospital payments both to other states and to Medicare. This is one of the first attempts to develop a comprehensive comparison of Medicaid inpatient hospital payments across states. The payment index was constructed by calculating […]