Medicaid state-directed payments (SDPs)

Senate Medicaid hearing highlights the debate over federal spending cuts

Cuts to federal Medicaid spending are necessary to streamline the program and don’t necessarily portend tough times for providers, conservative policymakers and analysts argued during a Senate hearing. The Aug. 4 hearing of the Senate Budget Committee included discussion of whether healthcare policies in the One Big Beautiful Bill Act (OBBBA) should be scaled back…

By Nick Hut August 6, 2026

Biggest SDP recipients raise concerns about implementing rule

Hospitals in the states that receive the most funding from state-directed payments (SDPs) identified the range of impacts from a proposed rule and suggested alternative approaches. The comments from hospitals and hospital advocacy groups came in response to a proposed rule implementing SDP provisions of the One Big Beautiful Bill Act (OBBBA). OBBBA, enacted a…

By Rich Daly July 28, 2026

Medicaid provider tax proposed rule could cut payments by $220 billion over 10 years

A proposed rule from CMS implements anticipated changes to the system of provider taxes that help fund supplemental reimbursement in Medicaid. The changes are required under the One Big Beautiful Bill Act (OBBBA, also referred to as the Working Families Tax Cut legislation), with the proposed rule filling in details. The repercussions of the rule…

By Nick Hut July 22, 2026

States push new hospital funding arrangements

States are implementing a growing number of initiatives to provide funding for rural or otherwise financially struggling hospitals. This push comes amid data showing that a record number of hospitals are financially distressed, and advocates warn that coming federal Medicaid cuts will worsen the situation. Indiana targeted funds Indiana hospitals celebrated a new arrangement within…

By Rich Daly July 7, 2026

FastFinance: Patient collections trends; SDP cuts rule

HFMA’s FastFinance newsletter is now a podcast. Host Rich Daly discusses the most current and relevant healthcare news, delivered in an easily digestible format. Hospitals and health systems have improved their front-end patient collections over the last year. But back-end collections are faltering. Also, this week’s Weird Number: $1.3 billion. That’s the amount of Medicaid…

By Rich Daly May 26, 2026

Hospitals see danger to SDPs in fraud fight

Hospitals are worried that a coming Trump administration fraud-fighting effort will go after Medicaid state-directed payments (SDPs). The concern was raised by various hospital advocates responding to the administration’s solicitation for targets in its coming anti-fraud regulations, called the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH). That request for information (RFI) specifically asked about fraud-fighting…

By Rich Daly April 14, 2026

Despite delays, hospitals optimistic on SDPs

Although at least one state has waited nine months for CMS approval of its state-directed payment (SDP) plan, hospital executives said the approval process continues to churn. So far this year, CMS has approved $26.2 billion in hospital-focused SDPs, according to a FastFinance count of the list of approved SDPs. That amount includes both the…

By Rich Daly March 24, 2026

Medicaid directed payments draw scrutiny, potential changes

As annual Medicaid state-directed payments (SDPs) exceed $100 billion annually, congressional advisers are calling for transparency, while critics emphasizing the need for change. Medicaid SDPs, which primarily benefit hospitals, have surged both in their number and total spending, according to a recent staff report from the Medicaid and CHIP Payment and Access Commission (MACPAC). In…

By Rich Daly December 6, 2024
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