Medicaid

Medicaid and CHIP Payment and Access Commission (MACPAC)

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 beneficiary. 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 a beneficiary may require that are included in the plan’s contract with the state.

The majority of Medicaid enrollees, largely non-disabled children and adults under age 65, are in managed care plans. However, the majority of Medicaid spending still occurs under FFS arrangements. The enrollment of high-cost populations, such as people with disabilities, in managed care has been more limited than for lower-cost populations. In addition, coverage of certain high-cost services (e.g., nursing home and other long-term services and supports) may be excluded from managed care contracts, although such arrangements are growing in number.

For more information: Provider payment and delivery systems

Fact sheets

Medicaid Inpatient Hospital Services Payment Policy
Medicaid Outpatient Hospital Services Payment Policy
Medicaid Physician Payment Policy
Medicaid Payment for Outpatient Prescription Drugs
Medicaid Nursing Facility Payment Policy
Medicaid Payment Policy for Federally Qualified Health Centers
Medicaid Durable Medical Equipment Payment Policy