Across the US, states use state directed payments to align Medicaid managed care plan payment rates with their goals for health care delivery and provider payments. States commonly use these arrangements to increase payments to hospitals and other providers and to support goals related to providers’ participation in Medicaid and beneficiaries’ access to care.
Since their creation in 2016, state directed payments have grown rapidly. They now account for tens of billions of dollars in annual Medicaid spending and accounted for more than a quarter of Medicaid managed care spending in 2025. In many states, state directed payment levels exceed traditional Medicaid fee-for-service rates and are often tied to commercial payment benchmarks.
However, the One Big Beautiful Bill Act and a recently proposed Centers for Medicare & Medicaid Services (CMS) rule aim to establish new limits on state directed payment levels that could reshape how Medicaid programs pay hospitals and providers. Providers that receive substantial state directed payment funding could lose revenue and, in some cases, may limit their provision of Medicaid-covered services.
Understanding the potential effects of these policy changes requires detailed data about state directed payments, but that information has been hard to track and compare across states. To address this challenge, we created the Medicaid State Directed Payments Database, which provides data about payment levels, provider types, and financing approaches across states.
Explore the Data
The Medicaid State Directed Payments Database brings together information from publicly available state directed payment preprints submitted to and approved by CMS into a standardized resource.
A summary version of the database below highlights key characteristics of each state directed payment arrangement, including:
- provider types
- payment approaches
- financing mechanisms
- spending levels
- stated program goals
To use and analyze the data directly, access the full database in the Urban Institute’s Data Catalog. It includes additional information from CMS-approved preprints, including payment rates (where available), provider tax rates, and sources of intergovernmental transfers.
Source: Centers for Medicare & Medicaid Services, “Approved State Directed Payment Preprints,” accessed October 6, 2026.
Notes: ACR = average commercial rate; SDP = state directed payment; SPA = state plan amendment; PHIP = private health insurance premium. Where appropriate, data were standardized across preprints (i.e., to present dollar amounts and dates in a standard format, and to standardize responses in the "Basis for SDP Payment Rates” column where possible). Otherwise, state responses are provided unedited. The only data element directly created by the research team is "SDP Goal Categories." The process for creating this field is described in detail in Urban’s Data Catalog.
