Six state Medicaid programs use value-based payments (VBP) for nursing home services; the states are: Arizona, Indiana, Minnesota, Ohio, Tennessee, and Texas. The VBP model links financial rewards to measures of quality. The state programs are as follows: Arizona operates two VBP programs. It has operated its voluntary VBP Initiative since 2013 within a managed care delivery system. The nursing facilities are able to participate in shared savings if they meet quality improvement and cost targets. In 2017, Arizona launched VBP differentials, also a voluntary program, within the managed care system to distinguish nursing facilities committed to . . .