Introduction
In April 2025, Florida hospitals celebrated an $8 billion windfall in supplemental Medicaid funds—a victory that highlights the power of strategic lobbying and savvy navigation of federal and state programs. This guide breaks down the process used by these hospitals, so you can apply similar steps to secure extra Medicaid payments for your facility. Whether you’re a hospital administrator, a finance director, or a state health official, understanding the State Directed Payment (SDP) program is key. The approval from the Centers for Medicare and Medicaid Services (CMS) on April 30, 2025, covers care from October 1, 2024, through September 30, 2025. But with new limits coming from the Trump 2025 tax cut bill, timing and strategy matter more than ever. Follow these steps—and check the prerequisites, steps, and tips—to build your own funding pipeline.
What You Need
- State legislative authorisation – Your state must pass laws or budget measures allowing the use of supplemental Medicaid payments via an SDP.
- Data on Medicaid patient volume – Accurate records of services provided to Medicaid enrollees, including dates, costs, and diagnoses.
- Lobbying resources – A team of lobbyists, hospital association support, and political connections (especially in politically influential states like Florida).
- CMS application materials – Understanding of CMS Form 1797 and related guidance for state-directed payments.
- Knowledge of federal limits – Awareness of the 2025 tax cut bill’s new caps on supplemental payments.
- Financial reserves – Upfront costs needed to cover program administration until the federal funds arrive.
Step-by-Step Process
Step 1: Understand the State Directed Payment (SDP) Mechanism
An SDP allows states to direct extra Medicaid funds to hospitals beyond base rates. Unlike standard managed care payments, these are supplemental and must be approved by CMS. Florida’s $8 billion windfall came from such a program covering one fiscal year (Oct 1–Sept 30). Study your state’s current waiver or state plan amendment options.
Step 2: Build State-Level Political Support
Hospitals in Florida lobbied heavily to get this funding approved. Form a coalition with your state hospital association. Meet with key legislators and the governor’s office to explain how the funds will offset uncompensated care. Present data showing Medicaid shortfalls and the economic impact of hospital closures.
Step 3: Prepare Your Application for CMS
Work with state Medicaid officials to draft the SDP proposal. Include:
- Justification – Why the extra payments are necessary (e.g., quality improvement, access preservation).
- Financing plan – How the state will cover the non-federal share (often through intergovernmental transfers or provider taxes).
- Compliance – Ensure the program meets federal rules on upper payment limits (UPL) and is budget-neutral for the federal government.
Step 4: Coordinate with CMS and Submit Timely
Florida’s application was approved on April 30, 2025. Submit your proposal well before the end of the state’s fiscal year to allow time for review. CMS release letters are typically public—monitor them for similar approvals that can serve as templates. Include a clear timeline for retroactive payments if possible, as Florida’s covered prior care.
Step 5: Lobby for State Legislative Authorization
Even before CMS gives the go-ahead, state lawmakers must sign off. Florida’s legislature approved the $8 billion in the same session. Use your coalition to advocate for a bill or budget line item. Tie the funding to specific hospital needs (e.g., rural facilities, safety-net hospitals).
Step 6: Navigate the New Federal Limits from the 2025 Tax Cut Bill
The Trump administration’s 2025 tax cut bill imposes caps on supplemental Medicaid payments. To stay ahead:
- Assess how the new caps affect your proposed payment amounts.
- Consult with health policy experts to adjust your application if necessary.
- Consider advocating for exceptions or transition rules.
Step 7: Implement and Monitor the Program
Once funds are approved, distribute them to hospitals according to the CMS-approved formula. Track utilization and outcomes to demonstrate value—this will strengthen future applications. Florida’s hospitals now routinely get paid higher commercial rates for Medicaid patients; aim for similar success.
Tips for Success
- Start early – The entire process, from lobbying to CMS approval, can take 12-18 months.
- Focus on high-need facilities – Rural and safety-net hospitals are often prioritized in SDP programs.
- Partner with your state hospital association – They can amplify your voice and share best practices.
- Stay informed on federal policy changes – The 2025 tax cut bill is just one example; new administrations may revise rules.
- Use inclusive language – Frame the funding as supporting patient care and community health, not just hospital finances.
- Prepare for audits – CMS scrutinizes supplemental payments for overpayment. Keep meticulous records.
By following these steps, your hospital can replicate the success seen in Florida—securing billions in extra Medicaid funding to expand access and improve financial stability. The key is combining political will, technical acumen, and a clear understanding of federal constraints.