Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official Medicaid.gov and state agency guidelines | Last Updated: March 2026
Massachusetts does not publish a single Medicaid fee schedule. Instead, MassHealth updates payment rates by provider type through 101 CMR regulations.
This guide breaks down every verified 2026 rate update so you know exactly what MassHealth pays.
Here you will find current rates for community health centers, physicians, DME, behavioral health, home health, and nursing facilities — all in one place.
Quick Summary
- MassHealth updates rates through separate 101 CMR regulations — not one master list
- Community health center rates increased effective January 1, 2026
- DME and oxygen rates updated effective March 1, 2026
- Behavioral health minimum fee schedules are confirmed for 2026
- Nursing facility rates from October 2025 remain active through mid-2026
- Physician rates were refiled in January 2026 with no broad increase
What Is a Medicaid Fee Schedule?
A Medicaid fee schedule is a list of payment rates. It tells providers how much Medicaid will pay for each covered service. Every state sets its own rates.
In Massachusetts, MassHealth manages the fee schedule. Rates are published under 101 CMR — the Code of Massachusetts Regulations. Each provider type has its own regulation number and rate table.
If you want to understand how MassHealth eligibility works, check our guide to Massachusetts Medicaid income limits in 2026.
Why Fee Schedules Matter
Fee schedules affect your access to care. When rates are fair, more providers accept MassHealth patients. Low rates can make it harder to find a doctor.
How Massachusetts Updates Rates
The Executive Office of Health and Human Services (EOHHS) updates rates individually. Each update goes through a public regulation process. Some rates change every year. Others stay the same for longer.
MassHealth Community Health Center Rates 2026
Community health centers (CHCs) serve many MassHealth members. These clinics offer primary care, dental, and behavioral health. New rates took effect on January 1, 2026.
Metro Boston CHC Rates
| Visit Type | 2026 Rate |
|---|---|
| Established Patient | $231.61 per visit |
| New Patient | $310.73 per visit |
Rest of Massachusetts CHC Rates
| Visit Type | 2026 Rate |
|---|---|
| Established Patient | $214.78 per visit |
| New Patient | $288.15 per visit |
These are Prospective Payment System (PPS) rates. They apply to both Health Safety Net and MassHealth visits. Metro Boston rates are higher due to cost-of-living differences.
Durable Medical Equipment & Oxygen Rates 2026
MassHealth updated DME and oxygen rates effective March 1, 2026. These changes fall under 101 CMR 322.00.
What Changed
The new regulation adjusts rates for specific equipment codes. Changes reflect current market pricing. Covered items include wheelchairs, oxygen equipment, and respiratory therapy devices.
How to Find Your Rate
Providers must check the 101 CMR 322.00 rate table directly. Each item has its own HCPCS code and rate. You can find the full table on the Mass.gov regulations page.
Physician & Medicine Service Rates 2026
There is no broad physician rate increase for 2026. MassHealth refiled 101 CMR 317.00 in January 2026. This keeps existing payment methods in place.
What the Refiling Means
A refiling does not mean new rates. It usually means MassHealth is maintaining current rates. It may also add new CPT codes from the annual code update.
2026 CPT Code Updates
MassHealth issued Administrative Bulletin 26-06. This bulletin adopts new 2025 CPT and HCPCS codes. Pricing for these codes is retroactive to January 1, 2025. No new 2026 pricing was added.
If you are comparing how Medicaid rates differ across states, our overview of the Medicaid fee schedule in 2026 covers the national picture.
Behavioral Health Fee Schedule 2026
MassHealth has confirmed minimum rates for behavioral health services in 2026. CMS approved these rates for Medicaid managed care plans.
Key Details
| Detail | Information |
|---|---|
| Effective Period | January 1, 2026 – December 31, 2026 |
| Applies To | Medicaid managed care plans |
| Requirement | Plans must pay at least the minimum rates |
Why This Matters
Minimum fee schedules protect providers. They make sure managed care plans do not pay below a set floor. This helps keep behavioral health providers in the MassHealth network.
Home Health Service Rates 2026
MassHealth proposed updates to home health rates in March 2026. These changes fall under 101 CMR 350.00.
Current Status
| Detail | Information |
|---|---|
| Status | Proposed — not yet final |
| Proposed Effective Date | August 1, 2026 |
| Rate Impact | Mostly flat funding with rule updates |
| Public Hearing | Scheduled for April 2026 |
Until the new regulation is finalized, verified 2025 rates remain in effect. Providers should watch for the final rule after the public comment period ends.
Nursing Facility Rates 2026
Nursing facility rates in Massachusetts follow an October 1 rate year. Current rates took effect October 1, 2025. They apply through at least September 30, 2026.
What Is Included
These rates fall under 101 CMR 206.00. They include quality adjustments based on 2025 performance scores. Facilities with higher quality scores may receive higher payments.
When New Rates Take Effect
Expect updated nursing facility rates by October 1, 2026. Until then, the current schedule is the legal authority for payments.
MassHealth Eligibility & Long-Term Care Limits 2026
Financial eligibility thresholds for long-term care and community waivers also increased for 2026. These limits determine who can receive MassHealth-funded nursing or waiver services.
| Category | 2026 Amount |
|---|---|
| Home & Community Based Waiver Income Limit | $2,982 per month |
| Community Spouse Resource Allowance (CSRA) | $162,660 maximum |
| Personal Needs Allowance (Nursing Home) | $72.80 per month |
The waiver income limit equals roughly 300% of the Federal Benefit Rate. The CSRA is the maximum assets a non-applicant spouse can keep.
To see how income limits work for other Medicaid groups, visit our Medicaid income limits by state 2026 page.
What to Do If Your Rate Code Is Missing
If you cannot find a 2026 rate for a specific CPT or HCPCS code, MassHealth likely defaults to the 2025 rate. Here is how rates carry forward:
- MassHealth only updates rates through 101 CMR regulations.
- If no new regulation exists for your provider type, the prior year’s regulation is still the legal authority.
- Check Mass.gov for the most recent 101 CMR filing for your service category.
- Contact MassHealth Provider Services if you still cannot find your rate.
You can also use our Medicaid eligibility calculator to check whether your patients qualify for MassHealth coverage.
Frequently Asked Questions
Q: Does Massachusetts have one single Medicaid fee schedule?
A: No. Massachusetts updates rates separately by provider type through 101 CMR regulations. Each service category — like physicians, DME, or nursing facilities — has its own rate table. You need to check the specific regulation for your provider type to find current MassHealth rates.
Q: When did MassHealth community health center rates change in 2026?
A: New community health center PPS rates took effect January 1, 2026. An established patient visit in Metro Boston now pays $231.61. A new patient visit pays $310.73. Rates outside Metro Boston are slightly lower at $214.78 and $288.15 respectively.
Q: Did MassHealth increase physician rates for 2026?
A: No broad physician rate increase was announced for 2026. MassHealth refiled 101 CMR 317.00 in January 2026 to maintain existing payment methods. Administrative Bulletin 26-06 added new CPT codes but used retroactive 2025 pricing. Current physician rates remain unchanged.
Q: What are the MassHealth nursing facility rates for 2026?
A: Nursing facility rates effective October 1, 2025, under 101 CMR 206.00 apply through mid-2026. These rates include quality-based adjustments from 2025 performance scores. New nursing facility rates are expected by October 1, 2026.
Q: What is the MassHealth income limit for home and community waivers in 2026?
A: The 2026 income limit for Home and Community Based Services waivers is $2,982 per month. This equals about 300% of the Federal Benefit Rate. The Community Spouse Resource Allowance is $162,660, which is the maximum assets a healthy spouse may keep.
Q: Are behavioral health providers guaranteed minimum rates under MassHealth in 2026?
A: Yes. CMS approved a minimum fee schedule for behavioral health outpatient services from January 1 to December 31, 2026. All MassHealth managed care plans must pay providers at least these minimum rates. This protects access to mental health and substance use treatment.
Sources & Disclaimer
Sources:
- Medicaid.gov — Federal Medicaid program information
- Healthcare.gov — Medicaid & CHIP — ACA and Medicaid overview
- Mass.gov — MassHealth Regulations — 101 CMR rate filings
Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official rate information, contact MassHealth Provider Services or visit Mass.gov.
Last Updated: March 2026
