On August 12, CMS released its 2025-2026 Medicaid Managed Care Rate Development Guide, which provides states and their actuaries with guidance for the development of Medicaid managed care capitation rates for rating periods starting between July 1, 2025, and June 30, 2026. States are expected to abide by the provisions in 42 CFR § 438 to ensure actuarial soundness.
The current version does not intend to replace prior versions but builds on the prior year’s guide and the rate certification experiences of both the agency and states. The rate development guide speaks to Medicaid managed care rates in general, for long-term care services, and new adult group capitation rates.