CMS proposes Medicare-based caps on state-directed Medicaid payments, comments due July 21
Issue
On May 22, 2026, CMS proposed a rule (CMS-2449-P) capping state-directed Medicaid payments at 100% of Medicare in expansion states and 110% in non-expansion states. Comments were due July 21, 2026, and compliance would begin January 1, 2029.
The rule is a proposal, and CMS projects about $775 billion in savings over ten years.
Key points
- The proposed caps are 100% of Medicare in expansion states and 110% elsewhere, with compliance from January 1, 2029 and existing payments falling 10 points yearly from 2028.
- Comments were due July 21, 2026, under docket CMS-2026-1916.
- CMS projects about $775 billion in savings over ten years, about $510 billion of it federal.
Sources for this story
CMS (CMS-2449-P); Association of Clinicians for the UnderservedPart of
- Medicaid financing and eligibility operations
Provider taxes and state-directed payments
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FQHC Talent. (2026, May 22). CMS proposes Medicare-based caps on state-directed Medicaid payments, comments due July 21. Source: CMS (CMS-2449-P); Association of Clinicians for the Underserved. Retrieved November 11, 2026, from https://www.fqhctalent.com/intel/cms-2449p-state-directed-payments-comment-deadline-july-2026