Last Updated: February 11, 2026
Illinois Medicaid Fee Schedule for 2026
The Illinois Medicaid Fee Schedule for 2026 sets payment rates for healthcare providers.
The Illinois Department of Healthcare and Family Services (HFS) updated all major fee schedules effective January 1, 2026.
These rates determine how much providers get paid for treating Medicaid patients.
Quick Facts About 2026 Illinois Medicaid Rates:
• Hospital rates updated with new wage indexes and high-cost drug carve-outs
• Dental services saw proposed 50% rate increases for children
• Practitioner schedules updated January 20, 2026
• Long-term care includes $0.80/hour wage increases for ICF aides
• Developmental disability services added wage increases for support staff
• All managed care plans must follow state fee schedules within 30 days
What Is the Illinois Medicaid Fee Schedule?
The Illinois Medicaid Fee Schedule lists maximum payment amounts for medical services. HFS creates these schedules each year.
Providers use them to bill for services they give to Medicaid patients. The fee schedule covers all healthcare providers in Illinois.
This includes doctors, dentists, hospitals, and nursing homes. Each provider type has its own schedule with different rates.
How Fee Schedules Work:
Fee-for-Service (FFS) providers get paid directly from HFS. Managed Care Organizations (MCOs) like Meridian and YouthCare use these rates too.
MCOs must update their payments within 30 days of new schedules.
Understanding Illinois Medicaid eligibility in 2026 helps you know who qualifies for these services.
The fee schedule only matters if patients meet income requirements.
Latest 2026 Fee Schedule Updates
Illinois released major updates to Medicaid rates starting January 1, 2026. HFS posted new schedules across all provider categories.
These changes affect how much providers earn for services.
Hospital Rates (Inpatient & Outpatient)
Hospital rate sheets changed significantly in 2026. HFS released new calculations for both inpatient and outpatient services on January 1, 2026.
Key Hospital Changes:
• Medicare IPPS wage indexes updated for outpatient EAPG rates
• High-cost drugs over $1 million are now carved out of bundled payments
• New reimbursement methodology for expensive medications
• Separate rate sheets available for each Illinois hospital
The wage index affects how much hospitals in Chicago versus downstate areas get paid. Urban hospitals typically receive higher base rates than rural facilities.
You can download hospital-specific rate sheets from the HFS Medical Providers website. Each hospital has unique rates based on location and services.
Dental Services Fee Schedule
The 2026 Dental Fee Schedule took effect January 1, 2026. HFS updated the file again on January 20, 2026, with final rate adjustments.
Major Dental Rate Changes:
Illinois lawmakers proposed a 50% increase for children’s dental services. This change aims to improve access to pediatric dental care statewide.
| Service | Code | Children (0-20) | Adults (21+) |
|---|---|---|---|
| Periodic Exam | D0120 | $29.40 | $28.00 |
| Child Cleaning | D1120 | $43.05 | N/A |
| Adult Cleaning | D1110 | N/A | $48.38 |
| Sealant (per tooth) | D1351 | $37.80 | N/A |
| Filling (1 surface) | D2140 | $36.40 | $36.40 |
| Crown | D2740 | $272.83 | $272.83 |
The dental rate increase helps more dentists accept Medicaid patients. Better reimbursement means better access to care for Illinois children.
Practitioner & Physician Rates
The Practitioner Fee Schedule received updates on January 20, 2026. These rates became effective December 31, 2025, creating retroactive billing options.
This schedule covers:
• Physicians (all specialties)
• Advanced Practice Nurses (APNs)
• Physician Assistants
• Other individual healthcare providers
Practitioners should download the latest Excel file from the HFS Practitioner Reimbursement page. The file contains thousands of procedure codes with specific rates.
Check if your patients meet Medicaid income limits by state in 2026 before billing services. Income requirements vary by household size and program type.
Provider-Specific Reimbursement Rates for 2026
Different provider types have unique rate structures in 2026. HFS created separate schedules for specialized services.
Each category has specific effective dates and requirements.
Long-Term Care Facilities
Long-term care rates took effect January 1, 2026. Nursing facilities received important updates this year.
LTC Rate Changes:
• $0.80 per hour wage increase for ICF (Intermediate Care Facility) aides
• Staffing add-on adjustments for all facilities
• Federal approval pending for some wage increases
• Facility-specific rates based on cost reports
Nursing homes use these rates to pay staff better. The wage increase helps facilities recruit and keep quality caregivers.
HFS calculates nursing facility rates individually. Each facility’s rate depends on:
- Historical cost reports
- Staffing levels and add-ons
- Medicaid patient census
- Geographic location
Developmental Disabilities Services
The Developmental Disabilities (DDD) rate table launched on January 1, 2026. This schedule includes major wage improvements for frontline workers.
DDD Service Updates:
• Wage increases for Direct Support Personnel (DSP)
• Higher rates for residential services
• Additional funding for frontline staff
• Inflation adjustments built into rates
These increases help agencies serving people with developmental disabilities. Better pay means more qualified staff staying in these important roles.
The 2026 Medicaid Fee Schedule comparison shows how Illinois rates compare nationally. Understanding differences helps providers make informed decisions.
Supplemental Payments
HFS posted supplemental payment calculations for January through March 2026. These payments go beyond standard fee schedules.
Two Types of Supplemental Payments:
- Directed Payments: Required payments to specific provider types
- FFS Supplemental Payments: Additional payments for fee-for-service providers
MCOs must make directed payments within state timelines. These payments boost reimbursement for critical services and underserved areas.
Providers can check payment amounts on the HFS notifications page. Payment schedules get updated quarterly throughout 2026.
How to Access Illinois Medicaid Fee Schedules
Finding official fee schedules ensures accurate billing. Always use current HFS files for reimbursement rates. Old schedules can lead to claim denials.
Step-by-Step Access Instructions:
- Visit the Illinois HFS website
- Go to “Medical Providers” section
- Click “Medicaid Reimbursement”
- Choose your provider type
- Download the latest Excel or PDF file
Provider Type Navigation:
• Practitioners: HFS > Medical Providers > Medicaid Reimbursement > Practitioner (updated 01/20/2026)
• Hospitals: HFS > Medical Providers > Medicaid Reimbursement > Hospital Rate Sheets (effective 01/01/2026)
• Dental: HFS > Medical Providers > Medicaid Reimbursement > Dental (2026 Dental Fee Schedule)
Always verify the file date before using rates. HFS makes retroactive adjustments sometimes. Using outdated schedules may cause payment delays or claim rejections.
Use the Illinois Medicaid calculator 2026 to estimate payments before submitting claims. Calculators help you budget and forecast revenue accurately.
Understanding Key Medicaid Terms
Learning Medicaid billing terms helps providers navigate fee schedules. HFS uses specific language in all rate documents.
Fee-for-Service (FFS):
Direct payment model where HFS pays providers from state funds. Providers submit claims and receive payment based on published fee schedules. FFS rates serve as the baseline for all MCO contracts.
Managed Care Organization (MCO):
Insurance plans that manage Medicaid benefits. Plans like Meridian and YouthCare must follow state fee schedules. MCOs typically pay a percentage of FFS rates or negotiate separate contracts.
EAPG (Enhanced Ambulatory Patient Groups):
Classification system for outpatient hospital services. EAPG rates get adjusted by Medicare wage indexes. Location affects how much hospitals receive for the same service.
Wage Index:
Geographic adjustment factor for hospital payments. Chicago-area hospitals have higher indexes than rural facilities. The index accounts for regional differences in labor costs.
Retroactive Adjustment:
Changes to rates that apply to past dates of service. HFS sometimes updates rates after the effective date. Providers can resubmit claims for higher payments when this happens.
Frequently Asked Questions
1. When did the 2026 Illinois Medicaid fee schedules take effect?
Most 2026 fee schedules became effective January 1, 2026. The practitioner schedule was updated January 20, 2026, with effective dates starting December 31, 2025. Hospital rates, dental schedules, and long-term care rates all began January 1, 2026. Always check the specific schedule for your provider type.
2. How much did children’s dental rates increase in 2026?
Illinois proposed a 50% increase in reimbursement rates for children’s dental services in 2026. This legislation aims to improve access to pediatric dental care statewide. The increase covers preventive services, cleanings, fillings, and other treatments for children ages 0-20. Higher rates encourage more dentists to accept Medicaid patients.
3. Where can I download the official Illinois Medicaid fee schedules?
Visit the Illinois Department of Healthcare and Family Services (HFS) website at hfs.illinois.gov. Navigate to Medical Providers, then Medicaid Reimbursement. Select your provider category (practitioner, hospital, dental, etc.). Download the latest Excel or PDF file dated for 2026. Always use official HFS files for accurate billing.
4. Do managed care plans have to follow the state fee schedule?
Yes, managed care organizations (MCOs) must implement state fee schedule updates within 30 days of receipt. MCOs like Meridian and YouthCare use the FFS rates as their baseline. Some plans pay a percentage of the FFS rate or negotiate separate contracts. State-directed payments must match published schedules exactly.
5. What is the wage increase for long-term care workers in 2026?
Long-term care facilities received a $0.80 per hour wage increase for ICF (Intermediate Care Facility) aides effective January 1, 2026. This increase is subject to federal approval. Developmental disability services also received wage increases for Direct Support Personnel and frontline staff. These raises help facilities recruit and retain qualified caregivers.
6. Can I bill retroactively if rates increased after my service date?
Yes, Illinois Medicaid allows retroactive claim adjustments when rates increase after the effective date. If HFS updates a fee schedule with a past effective date, providers can resubmit claims for the higher amount. Check the HFS notifications page for retroactive adjustment announcements. Submit corrected claims within the standard timely filing limits.
Official Sources:
• Illinois Department of Healthcare and Family Services: hfs.illinois.gov
• HFS Medicaid Reimbursement: hfs.illinois.gov/medicalproviders/medicaidreimbursement.html
