Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official Medicaid.gov and Maine DHHS guidelines | Last Updated: March 2026
The MaineCare fee schedule for 2026 is not a single document. It is a collection of section-specific reimbursement lists.
These lists are updated throughout the year by the Maine Department of Health and Human Services (DHHS), Office of MaineCare Services.
The biggest 2026 updates took effect on January 1, 2026. They are driven by Medicare benchmarking and Cost-of-Living Adjustments (COLA).
This guide breaks down every confirmed change, how to access official rate files, and what providers and families need to know.
Quick Summary
- MaineCare sets provider rates by policy section, not one master list.
- Most Medicare-covered codes are now reimbursed at 72.4% of 2026 Medicare rates.
- A 1.0% COLA increase applies to many home and community-based services.
- Enhanced Primary Care Providers receive 100% of the Medicare rate.
- The provider enrollment fee increased to $750 in 2026.
- Official fee schedules are posted on the Health PAS Online Portal.
- Need to check if you qualify? Use our MaineCare Medicaid income limits in 2026 guide.
What Is the MaineCare Fee Schedule?
The MaineCare fee schedule is the official list of rates that Maine pays healthcare providers.
Each medical service has a set reimbursement amount. Providers bill MaineCare using CPT and HCPCS codes.
The fee schedule tells them how much they will be paid for each code.
Why It Matters
These rates affect which doctors accept MaineCare patients.
Higher rates mean more providers are willing to participate. Lower rates can limit access to care.
Maine updates these rates each year to keep up with costs.
How Maine Organizes Its Fee Schedules
Maine does not publish one single fee schedule. Instead, it organizes rates by policy section.
Each section covers a type of service. For example, Section 90 covers Physician Services.
Section 65 covers Behavioral Health. Providers must look up the specific section that applies to their services.
How to Access the 2026 MaineCare Fee Schedules
You can find every official 2026 fee schedule on the state’s online portal.
The schedules list specific CPT/HCPCS codes and their reimbursement amounts in Excel or PDF format.
Where to Find Them
Go to the MaineCare Health PAS Online Portal, then navigate to Provider Fee Schedules > Rate Setting. The direct access point is:
https://mainecare.maine.gov/Provider%20Fee%20Schedules/Forms/Publication.aspx
Tips for Using the Portal
- Select the specific policy section you need (e.g., “Section 90 — Physician Services”).
- Check the “modified” column for the most recent upload date.
- Use files updated after February 13, 2026, to get corrected versions for Sections 68 (OT) and 85 (PT).
- The 2026 files are active and searchable now.
Key 2026 Rate Updates and Methodologies
Maine enacted significant rate updates on January 1, 2026. These changes come from the state’s “Rate Reform” legislation.
The two main updates are Medicare benchmarking and COLA increases.
Medicare Benchmarking (72.4% Rule)
For many service types, MaineCare now pays 72.4% of the 2026 Maine Medicare rate.
This applies to all Medicare-covered codes in the following sections:
| Section | Service Type |
|---|---|
| 14 | Advanced Practice Registered Nursing (APRN) |
| 15 | Chiropractic |
| 30 | Family Planning |
| 65 | Behavioral Health |
| 68 | Occupational Therapy |
| 75 | Vision |
| 85 | Physical Therapy |
| 90 | Physician Services |
| 95 | Podiatry |
| 101 | Medical Imaging |
| 109 | Speech and Hearing |
Source: Maine DHHS Provider Bulletin, December 29, 2025 (CY26 Medicare Standardization).
Physician Services (Section 90) — Special Rule
Standard physician services follow the 72.4% benchmark. However, Enhanced Primary Care Providers receive 100% of the 2026 Medicare rate. This is a meaningful boost for primary care access.
Behavioral Health (Section 65) — COLA Correction
The initial 2026 Behavioral Health rates had a COLA calculation error. Maine DHHS issued a corrected fee schedule on January 6, 2026. Providers must use the corrected version. The original upload is no longer accurate.
Source: Maine DHHS Correction Notice, January 5, 2026.
2026 Cost-of-Living Adjustment (COLA) Details
A 1.0% COLA increase took effect on January 1, 2026. It applies to many home and community-based services. This increase is above previously established rates.
Sections That Received the 1.0% COLA
| Section | Service Type |
|---|---|
| 2 | Adult Family Care |
| 12 | Consumer Directed Attendant |
| 13 | Targeted Case Management |
| 17 | Community Support |
| 18 | HCBS Brain Injury |
| 19 | HCBS Elderly and Disabilities |
| 21 | HCBS Intellectual Disabilities/Autism |
| 26 | Day Health |
| 28 | Rehabilitative/Community Support for Children |
| 29 | Support for Intellectual Disabilities/Autism |
| 60 | DME/Supplies (Non-Medicare) |
| 65 | Behavioral Health |
| 90 | Physician (Non-Medicare) |
| 92 | Behavioral Health Home |
| 96 | Private Duty Nursing/Personal Care |
The COLA does not apply to cross-referenced Medicare rates. It only affects non-Medicare or separately eligible service codes.
Source: Maine DHHS Bulletin, December 1, 2025, citing P.L. 2025, Ch. 388 (Part GGG).
2026 Rate Determination Schedule
Maine published the Final CY26 Rate Determination Schedule on January 20, 2026.
This schedule outlines which service areas are under active rate review. It includes benchmarking studies and stakeholder consultations.
Services Still Under Review (No Final Rates Yet)
Many service areas have rate reviews in progress. These do not have confirmed 2026 fee schedules yet:
- Community Paramedicine and Coordinated Specialty Care
- Doula Services and Lactation
- Multiple HCBS waiver sections (12, 18, 19, 20, 21, 29, 40, 96, 102)
- Hospice (Section 43) and Palliative Care
- Nursing Facility Specialty Units (Section 67)
- Pharmacy Dispensing Fees (Section 80)
- Dental (Section 25) and Hospitals Professional (Section 45)
- School Health/Early Intervention (Section 106)
Draft materials and public comments are posted for some areas, but effective dates remain TBD.
Source: Final CY26 Rate Determination Schedule (PDF)
Want to compare rates across the country? See our guide to the full Medicaid Fee Schedule 2026 by state.
Administrative Updates for Providers in 2026
Providers should know about two important administrative changes that affect enrollment and pharmacy billing.
Provider Enrollment Fee Increase
The application fee for new, reactivating, or revalidating providers increased to $750. This took effect on January 1, 2026.
The increase aligns with federal CMS requirements. It also applies to providers adding a new service location.
Source: Maine DHHS/CMS Update, December 9, 2025.
Pharmacy Preferred Drug List (PDL)
The 2026 Preferred Drug List is available in both Excel and PDF formats. It took effect on January 1, 2026.
Providers can download it from the MaineCare PDL site at mainecarepdl.org.
2026 Eligibility Limits — Related Context
MaineCare fee schedules tell providers what they earn. But families also need to know if they qualify. Key 2026 financial eligibility limits include:
| Category | 2026 Limit |
|---|---|
| Long-Term Care Income Limit | $2,982/month |
| Community Spouse Asset Allowance | $162,660 |
| Home Equity Limit | $1,130,000 |
For a full breakdown of who qualifies and income thresholds by household size, visit our Medicaid income limits by state in 2026 page.
Frequently Asked Questions
Q: Where can I find the official MaineCare fee schedule for 2026?
A: Go to the MaineCare Health PAS Online Portal and select “Provider Fee Schedules” in the Rate Setting folder. Each policy section has its own downloadable Excel or PDF file with specific codes and rates. Files are updated throughout the year, so always check the “modified” date.
Q: What is the 72.4% Medicare benchmarking rule?
A: For many MaineCare service sections, the 2026 reimbursement rate is set at 72.4% of the current Maine Medicare rate. This applies to sections like Physician Services, Physical Therapy, Occupational Therapy, Vision, and others. Enhanced Primary Care Providers are an exception — they receive 100% of the Medicare rate.
Q: Did MaineCare rates increase in 2026?
A: Yes. A 1.0% Cost-of-Living Adjustment (COLA) took effect January 1, 2026 for many home and community-based services. Additionally, Medicare benchmarking updated rates for clinical service sections. Some providers saw increases while others saw adjustments based on the new 72.4% formula.
Q: How much is the MaineCare provider enrollment fee in 2026?
A: The enrollment application fee is $750 as of January 1, 2026. This applies to new providers, those reactivating their enrollment, revalidating, or adding a new service location. The increase aligns with federal CMS requirements.
Q: Are all MaineCare service rates finalized for 2026?
A: No. Many service areas are still under active rate review. Services like dental, hospice, nursing facility specialty units, pharmacy dispensing fees, and school health have no confirmed 2026 fee schedules yet. The state published a rate determination schedule on January 20, 2026 outlining the review timeline.
Q: Does MaineCare cover dental services in Maine?
A: MaineCare does cover dental services under Section 25 of the Benefits Manual. However, the 2026 dental fee schedule is still under review with no finalized rates yet. Current coverage includes preventive, diagnostic, and restorative dental care for eligible members. Check the portal for the latest updates.
Sources & Disclaimer
Sources:
- Maine DHHS Provider Bulletins (December 2025 – March 2026)
- MaineCare Health PAS Online Portal — Provider Fee Schedules
- CY26 Rate Determination Schedule (PDF)
- MaineCare PDL
- Maine DHHS Rate System Reform
Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official eligibility or rate information, contact the Maine Office of MaineCare Services or visit Medicaid.gov.
