Trump Administration Advances Cap on Medicaid Provider Payments

The Trump administration released guidance Tuesday informing states of new limits on direct payments to Medicaid providers while it works on finishing its final rule.

Under the guidance, payments for inpatient nursing facilities, inpatient and outpatient hospitals, and qualified practitioners will be capped at 100% of what Medicare pays for these services in states that have expanded Medicaid eligibility and 110% in non-expansion states. In the absence of a Medicare rate, the Medicaid state plan rate will apply.

The Medicaid program allows states to decide how managed care plans pay providers through direct payments. Although not originally widespread, annual ...