CMS Proposes Major Changes to Medicaid Managed Care and State Directed Payments

The Centers for Medicare & Medicaid Services issued proposed rule CMS-2449-P on May 21, 2026, addressing Medicaid managed care state directed payments and fee-for-service targeted practitioner payments. The rule represents significant changes to how states can direct Medicaid spending through managed care arrangements and targeted payment structures.

State directed payment reforms

• ▪CMS proposed rule CMS-2449-P addresses Medicaid Managed Care State Directed Payments and Medicaid Fee-For-Service Targeted Medicaid Practitioner Payments.

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