Last Updated: January 26, 2026
Page Contents
- 1 What Are Medicaid Fee Schedules in 2026?
- 2 What Is a Medicaid Fee Schedule?
- 3 Key Terms You Need to Know
- 4 What Changed in 2026?
- 5 2026 National Payment Rates
- 6 How to Find Your State’s Fee Schedule
- 7 State-Specific Examples for 2026
- 8 Understanding Fee Schedule Documents
- 9 Managed Care vs. Fee-For-Service
- 10 Important Things to Remember
- 11 Where to Find Official State Resources
- 12 Frequently Asked Questions (FAQs)
- 13 Next Steps
What Are Medicaid Fee Schedules in 2026?
Medicaid fee schedules show how much your state pays doctors and hospitals. Each state sets its own rates.
In 2026, new federal rules require states to publish these rates online.
Quick Summary:
- Medicaid fee schedules list payment rates for medical services
- Each state has different rates (no national standard exists)
- States must publish rates online by July 1, 2026
- New rules cut hospital payments but raise office visit rates
- Medicaid typically pays 30–40% less than Medicare
- Your eligibility depends on income limits in your state
What Is a Medicaid Fee Schedule?
A Medicaid fee schedule is a public list of payment amounts. It shows what your state Medicaid program pays healthcare providers for each medical service.
Why Fee Schedules Matter
Doctors use fee schedules to know their payment amount. Patients use them to understand coverage. States use them to control healthcare costs.
Not every Medicaid patient uses fee-for-service payment. Many states use managed care plans instead. These plans negotiate their own rates with doctors.
Key Terms You Need to Know
Understanding fee schedules is easier when you know these terms.
Fee-For-Service (FFS)
This is the traditional payment model. The state pays doctors directly for each service. Fee schedules apply to FFS Medicaid.
Managed Care Organizations (MCOs)
These are private insurance companies. States hire them to manage Medicaid benefits. MCOs set their own payment rates.
Conversion Factor
This is a dollar amount used in calculations. For 2026, the conversion factor is $33.57 for some providers. It’s $33.40 for others.
Medicaid-to-Medicare Fee Index
This measures how Medicaid rates compare to Medicare. Most states pay 30–40% less than Medicare rates.
What Changed in 2026?
Several major updates affect Medicaid payments this year. These changes impact both providers and patients across all states.
New Public Reporting Rules
States must publish complete fee schedules online by July 1, 2026. They must also compare Medicaid rates to Medicare rates. This helps people see reimbursement gaps.
The goal is transparency. People can now see exactly what their state pays doctors.
Efficiency Adjustment
A new -2.5% efficiency adjustment applies to most services. This reflects technology improvements in healthcare. Time-based services like therapy are exempt from this cut.
Site of Service Changes
CMS shifted payments from hospitals to office settings. In 2026, hospital-based services may see payment cuts around 7%. Office-based practices may see increases around 4%.
This encourages care in lower-cost settings. It helps control Medicaid spending.
Telehealth Payment Updates
Many states now pay the same rate for telehealth visits. The telehealth facility fee increased to $31.85 in 2026. This is up from $31.01 in 2025.
2026 National Payment Rates
While states set their own rates, some federal standards exist. Here are key 2026 payment amounts.
| Service Type | 2026 Rate | Notes |
|---|---|---|
| Inpatient Hospital (Per Day) | $5,707 (Lower 48 states) | Alaska: $5,208 |
| Outpatient Visit | $826 (Lower 48 states) | Alaska: $1,222 |
| Telehealth Facility Fee | $31.85 | Increased from 2025 |
| Skin Substitutes | $127.28 per cm² | Blended rate |
These are baseline amounts. Your state may pay more or less. Check your state’s official fee schedule for exact rates.
If you’re unsure whether you qualify for Medicaid, review the Medicaid income limits by state 2026 to see if you meet requirements.
How to Find Your State’s Fee Schedule
Every state publishes fee schedules differently. Follow these steps to find your state’s 2026 rates.
Step 1: Search for Your State
Use this search format: “[Your State] Medicaid Provider Fee Schedule 2026”
Example: “Texas Medicaid Provider Fee Schedule 2026”
Step 2: Find the Provider Section
Look for website sections labeled:
- “For Providers”
- “Claims & Billing”
- “Fee Schedules”
- “Rates and Reimbursement”
Step 3: Select Your Service Type
States often separate schedules by provider type:
- Physician services
- Dental services
- Durable medical equipment (DME)
- Ambulance services
- Behavioral health
Step 4: Check the Effective Date
Make sure the file says “Effective 01/01/2026” or “Effective 07/01/2025.” Some states update in July instead of January.
Step 5: Download the File
Fee schedules usually come as Excel or PDF files. Download and save for reference.
State-Specific Examples for 2026
Here’s what several states are doing with Medicaid rates this year.
Colorado
Colorado proposed reducing provider rates to 85% of Medicare rates. This applies to fiscal year 2027. The state is managing budget constraints.
Idaho
Idaho extended its 4% provider rate reductions. This continues cost-saving measures from previous years.
Washington
Washington submitted State Plan Amendment (SPA) 26-0002. This updates fee schedule effective dates for January 2026. Check the Washington state portal for details.
Indiana
Indiana updates its Professional Fee Schedule monthly. Updates happen on the second Tuesday of each month. Visit the Indiana Medicaid portal for current rates.
North Carolina
North Carolina updated its fee schedule on January 5, 2026. Access it through the NC DHHS website.
Mississippi
Mississippi has separate schedules for waivers and clinical services. Both were updated in January 2026.
California (Medi-Cal)
California uses a “rates list” instead of a single schedule. Search the Medi-Cal Rates database online.
Texas
Texas publishes schedules through TMHP (Texas Medicaid & Healthcare Partnership). Look for “Static Fee Schedules” on their website.
For more information about qualifying for Medicaid in your state, see our guide on Medicaid eligibility 2026.
Understanding Fee Schedule Documents
When you open a fee schedule file, you’ll see several columns. Here’s what they mean.
Procedure Code
This is a 5-digit CPT or HCPCS code. Example: 99213 is a standard office visit code.
Modifier
A 2-digit code showing variations. Example: Modifier 26 means professional component only.
Payment Amount
The dollar amount your state pays. Some states list “participating” and “non-participating” rates separately.
Facility vs. Non-Facility
- Facility: Payment if service happens in a hospital (usually lower)
- Non-Facility: Payment if service happens in a private office (usually higher)
Prior Authorization (PA)
Shows “Y” or “N” for whether permission is needed before service. Prior authorization prevents surprise denials.
Managed Care vs. Fee-For-Service
Not all Medicaid payments follow fee schedules. Understanding your plan type matters.
Fee-For-Service Plans
The state pays providers directly. Fee schedules set exact payment amounts. This is the traditional Medicaid model.
Managed Care Plans
Private insurers manage your benefits. They negotiate their own rates with doctors. Rates may be higher or lower than state fee schedules.
Most states now use managed care for most beneficiaries. Your plan documents will show your coverage details.
How to Check Your Plan Type
Look at your Medicaid card. If it shows an insurance company name (like UnitedHealthcare or Molina), you’re in managed care. If it just says your state name, you’re likely in fee-for-service.
If you need help applying for Medicaid, read our step-by-step guide on how to apply for Medicaid.
Important Things to Remember
Fee schedules don’t tell the whole story. Keep these points in mind.
Published Rates Are Base Amounts
Fee schedules show base rates only. They don’t include:
- Supplemental payments to hospitals
- Quality bonuses for providers
- Disproportionate Share Hospital (DSH) payments
- End-of-year incentive payments
Updates Take Time
Some states are slow to publish new schedules. If you don’t see a 2026 document, the 2025 schedule likely still applies. Check back after July 1, 2026.
Rates Vary Widely
Medicaid pays differently than Medicare or private insurance. Don’t assume Medicare rates apply to Medicaid services.
Prior Authorization Requirements
Many services require approval before treatment. Check the PA column carefully. Unapproved services may be denied.
Where to Find Official State Resources
Always use official government websites for accurate information. Here are trusted sources.
Federal Resources
- CMS Medicaid.gov: https://www.medicaid.gov
- CMS Fee Schedule Information: Official federal payment policies
State Medicaid Agencies
Search for “[Your State] Department of Medicaid” or “[Your State] Department of Health and Human Services.”
Look for the provider portal section on state websites. Fee schedules are usually under “Provider Resources” or “Claims and Billing.”
State Examples
- Indiana: Indiana Medicaid Fee Schedules portal
- Mississippi: MS Division of Medicaid website
- Ohio: Ohio Department of Medicaid schedules
- North Carolina: NC DHHS Medicaid fee schedules
Frequently Asked Questions (FAQs)
What is a Medicaid fee schedule?
A Medicaid fee schedule lists payment rates for medical services. Each state creates its own schedule. It shows what doctors and hospitals receive for treating Medicaid patients. Rates vary by state and service type.
Do all states use the same Medicaid rates?
No. Each state sets its own Medicaid payment rates. There is no national fee schedule. States consider their budgets and local costs. Some states pay close to Medicare rates. Others pay 30–40% less.
When will states publish 2026 fee schedules?
States must publish complete fee schedules online by July 1, 2026. Some states already updated rates in January 2026. Others update on their fiscal year schedule. Check your state Medicaid website for current information.
How much does Medicaid pay compared to Medicare?
Medicaid typically pays 30–40% less than Medicare. The exact difference varies by state and service. The new 2026 rules require states to publish these comparisons publicly for transparency.
Are telehealth visits paid the same as in-person visits?
Many states now pay equal rates for telehealth and in-person visits. This is called “parity.” The 2026 telehealth facility fee is $31.85. Check your state’s specific telehealth policies for details.
Check the “PA” column in your state’s fee schedule. It shows “Y” for yes or “N” for no. You can also call your Medicaid plan. Prior authorization must be obtained before receiving certain services.
Next Steps
Finding your state’s Medicaid fee schedule is now easier with new transparency rules. Use the official state Medicaid website for accurate, up-to-date information.
Remember to check effective dates and understand whether you’re in fee-for-service or managed care. Rates vary significantly by state and service type.
For questions about coverage, contact your state Medicaid office directly.
Sources:
- Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov
- Medicaid.gov Official Portal: https://www.medicaid.gov
- State Medicaid Agency Websites (various states)
This article provides general information about Medicaid fee schedules. Always consult official state sources for specific rates and requirements in your area.
