Starting July 1, 2026, all states must post Medicaid payment rates online. Unlike Medicare’s single national fee schedule, Medicaid operates 51 separate state programs.
Each state sets its own rates, which typically pay 30-40% less than Medicare.
Quick Summary:
- Federal transparency rules take effect July 1, 2026
- All 50 states have different fee schedules
- Rates vary by state, region, and provider type
- States update rates at different times throughout the year
- You can find rates on your state Medicaid website
- Most states now have January 2026 rates available
What Is a Medicaid Fee Schedule?
A Medicaid fee schedule lists payment amounts for services.
It shows how much providers get paid.
Each state creates its own schedule. Rates change based on:
- Your location (urban vs. rural)
- Service type (office visit, surgery, etc.)
- Patient age (child vs. adult)
- Provider specialty
Example: A doctor visit in Virginia pays $231.61 in Northern Virginia but only $214.78 in other areas.
New Federal Rules for 2026
Transparency Requirements (Effective July 1, 2026)
States must now:
✅ Post all fee schedules online
✅ Update rates within 1 month of approval
✅ Compare Medicaid rates to Medicare rates
✅ Organize rates by age group and location
These rules help providers and patients see payment information easily.
How Medicaid Rates Compare to Medicare
Medicaid typically pays 30-40% less than Medicare.
Example comparison:
- Medicare pays: $100 for an office visit
- Medicaid pays: $60-$70 for the same visit
Some services pay even less. Rates vary widely by state.
States must now publish these comparisons for:
- Primary care services
- OB/GYN services
- Mental health services
- Substance use disorder treatment
Source: CMS Medicaid Payment Transparency Rule
State-by-State Rate Updates for 2026
States with January 2026 Updates
Indiana
- Physician fee schedule available
- Excel format download ready
Iowa
- HCBS waiver rates effective Jan. 1, 2026
- New billing codes implemented
Nebraska
- Clinical lab rates: January 2026
- Dental services: January 2026
- FQHC rates: January 2026
- Transportation: January 2026
New York
- Radiology fee schedule: Jan. 1, 2026
- Surgery fee schedule: Jan. 1, 2026
- Excel format available
Ohio
- Prenatal care rate increases
- New dental codes covered
- Diabetes prevention counseling added
Pennsylvania
- Outpatient fee schedule updated
- Private duty nursing rates revised
- Valid through Dec. 31, 2026
Washington
- Routine coding updates
- Budget-neutral changes
- Aligned with CMS requirements
States with July 2026 Updates (State Fiscal Year)
Colorado
- 1.6% rate increase approved
- Effective July 1, 2025 (for FY 2025-26)
- Dental and nursing facility schedules updated
Virginia
- Annual updates effective July 1
- Northern Virginia: $23.81/hour (personal care)
- Rest of state: $20.23/hour (personal care)
States with October Updates (Federal Fiscal Year)
Arizona
- Physician rates effective Oct. 1, 2025
- Nursing facility increases: 0.70%-0.77%
- Urban, rural, and regional rates published
Mississippi
- Dental fees: October 2025
- Hearing and vision: October 2025
- Mental health services: October 2025
Other State Updates
California (Medi-Cal)
- Updates monthly (15th of each month)
- Behavioral health schedules for FY 2025-26
Florida
- 25+ provider type categories
- Updates throughout 2025
Georgia
- Rates for fiscal year ending June 30, 2026
- Based on 2023 cost reports
Illinois
- FQHC medical rates: $181.63 – $220.78
- Dental rates: $130.38 – $165.30
- Behavioral health: $57.91 – $88.11
Massachusetts
- Metro Boston: $231.61 (established patient)
- Rest of state: $214.78
South Dakota
- Multiple fiscal calendars used
- Quarterly drug updates
- Comprehensive service categories
Texas
- Provider enrollment fee: $750 (2026)
- Static schedules by specialty
- Quarterly updates maintained
Sources: State Medicaid agency websites, Medicaid.gov
How to Find Your State’s Fee Schedule
Step 1: Visit Your State Medicaid Website
Search: “[Your state] Medicaid fee schedule”
Example: “Ohio Medicaid fee schedule”
Step 2: Look for Provider Resources
Common page names:
- Provider Rates
- Fee Schedules
- Reimbursement Information
- Billing and Coding
Step 3: Select Your Provider Type
Categories include:
- Physician services
- Dental services
- Behavioral health
- Hospital services
- Home health
- Transportation
Step 4: Download the Schedule
Most states offer:
- Excel spreadsheets
- PDF documents
- Online lookup tools
Official state Medicaid websites:
Why Rates Vary by State
Geographic Differences
Urban vs. Rural:
- Cities typically pay more
- Rural areas pay less
- Based on practice costs
State Examples:
- Virginia: 2 rate regions (Northern VA vs. rest of state)
- Arizona: 4 regions (urban, rural, Flagstaff, Tucson)
Population Differences
Rates vary by patient age:
- Pediatric rates (under 21)
- Adult rates (21+)
- Geriatric rates (65+)
Provider Type Differences
Payment varies by:
- Office-based vs. hospital-based
- Independent vs. hospital-owned
- Specialty type
Update Schedule Differences
When states update rates:
- January updates: 7 states
- July updates: 5 states
- October updates: 3 states
- Monthly updates: California
- Quarterly updates: Texas, South Dakota
Important 2026 Deadlines
July 1, 2026
- All states must post fee schedules online
- Transparency rules take full effect
- Advisory groups must be formed
Throughout 2026
- States update rates at different times
- Check your state’s schedule
- Monitor mid-year changes
Quarterly Updates
- Drug and biological rates change every 3 months
- Check Q1, Q2, Q3, Q4 schedules
Key Terms to Know
Fee-for-Service (FFS): Payment for each service provided
Geographic Practice Cost Index (GPCI): Adjustment for regional cost differences
Managed Care Organization (MCO): Private company managing Medicaid benefits
State Plan Amendment (SPA): Official rate change approval
CPT Codes: Procedure codes for billing
HCPCS Codes: Healthcare procedure coding system
Telehealth Payment in 2026
Only 50% of states pay the same for telehealth as in-person visits.
Most states:
- Cover telehealth services
- Pay lower rates than office visits
- Require specific documentation
What providers must document:
- Medical necessity
- Visit type (phone, video)
- Patient location
- Patient consent
FAQs
Q: When do 2026 Medicaid rates take effect?
It depends on your state. Some states update in January, others in July or October. Check your state Medicaid website for exact dates.
Q: How much less does Medicaid pay than Medicare?
Medicaid typically pays 30-40% less than Medicare. The gap varies by state and service type. Some states pay more, others pay significantly less.
Q: Where can I find my state’s current fee schedule?
Visit your state Medicaid agency website. Look for “Provider Rates” or “Fee Schedules” in the provider section. Most schedules are downloadable.
Q: Do all states have the same Medicaid rates?
No. Each state sets its own rates. Payment amounts vary widely by state, region, provider type, and service. There is no national Medicaid fee schedule.
Q: What are the new transparency rules for 2026?
By July 1, 2026, all states must post fee schedules online, update them monthly, and compare rates to Medicare. This improves access to payment information.
Q: How often do Medicaid rates change?
Most states update rates once yearly. Some update quarterly for drugs. California updates monthly. Check your state’s schedule for specific timing.
Next Steps
- Find your state’s fee schedule on your Medicaid agency website
- Check the effective date for current rates
- Review rates for your specialty and service type
- Monitor updates throughout 2026
- Compare to Medicare rates when available
- Join your state’s advisory group if eligible
Need help? Contact your state Medicaid provider services department.
Sources:
- CMS Medicaid Fee Schedules
- Medicaid.gov State Resources
- Individual state Medicaid agency websites
