In response to the Medicaid managed care final rule, many states have recently gained approval from the Centers for Medicare and Medicaid Services’ (CMS) for “state directed payment” arrangements that support delivery system and provider payment reforms. Through these arrangements, states are permitted to direct managed care plans to make specified payments to healthcare providers that support overall Medicaid program goals and objectives. Milliman has conducted a comprehensive review of approved state directed payment arrangements to date and has summarized the findings on the types of approved arrangements.