Implementation of 2025 Reconciliation Law: Medicaid Managed Care Rate Setting Uncertainty & Potential Plan Exits
This policy watch examines recent and anticipated managed care rate setting challenges and the potential implications of MCO exits.
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Analysis: At Least 37 States Have Medicaid State Directed Payments for Hospital Services That Could Be Reduced by the 2025 Reconciliation Law Limits
News ReleaseAn estimated $60 billion in federal Medicaid spending in 37 states (including the District of Columbia) would likely exceed new federal limits on state directed payments for hospital services once fully implemented, a new KFF analysis finds. States with the biggest potential reductions in Medicaid payments to hospitals include California, Illinois, Kentucky, Texas, North Carolina, Louisiana, Arizona and Michigan.
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At Least 37 States Have Medicaid State Directed Payments for Hospital Services That Could Be Reduced by the 2025 Reconciliation Law Limits
Issue BriefThis analysis estimates the number of states impacted by and the amount of current federal spending on Medicaid state directed payments for hospital services that exceeds the new limits established by the 2025 reconciliation law when fully implemented.
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Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain
Issue BriefThis analysis of available 2025 prior authorization data finds insurers denied at least 1 in 8 standard requests for prior authorization across three insurance markets: Medicare Advantage, Medicaid managed care, and the federally facilitated ACA Marketplaces. Denial rates varied wide segments by insurer. The analysis highlights limitations of the data and challenges for consumers interpreting it.
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Forthcoming Policy Changes to Medicaid State Directed Payments
Issue BriefThe 2025 reconciliation law reduced federal Medicaid spending by an estimated $911 billion from 2025 through 2034, some of which stems from new restrictions on Medicaid state directed payments (SDPs) for hospital and other health care services. This issue brief describes SDPs and forthcoming policy changes stemming from the 2025 reconciliation law and the proposed regulation to implement those requirements and make other changes.
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Federal Medicaid Spending Through State Directed Payments Nears $100 Billion Annually Across 41 States, With New Limits Set to Reduce Funding to States
News ReleaseForty states and DC currently receive $93 billion in annual federal Medicaid spending through state directed payments (SDPs) and may be at risk due to forthcoming limits on these payments, according to new KFF estimates. Annual federal spending on SDPs is highest in California (an estimated $10.6 billion)—followed by Texas ($6.3 billion), North Carolina ($5.2 billion), and Illinois ($5.1 billion).
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Spending on Medicaid State Directed Payments Before New Limits Take Effect
Issue BriefThis issue brief analyzes Medicaid spending by state on SDPs that require prior CMS approval to better understand the use of SDPs before new limits in the reconciliation law take effect.
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Medicaid MCO For-Profit Parent Firm Financial Information
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Medicaid Managed Care Penetration Rates by Eligibility Group
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10 Things to Know About Medicaid Managed Care
Issue BriefOur updated explainer provides an overview of comprehensive managed care, the most common way states deliver Medicaid services to enrollees.