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.

These data were scraped from State Directed Payment Preprints posted by CMS. A complete list of data fields is available in the data dictionary. This dataset will be updated pending receipt of appendices requested via a Freedom of Information Act request.