Minnesota Medicaid Fee Schedule 2026: Rates, Access & Complete Guide

Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official Medicaid.gov and Minnesota DHS guidelines | Last Updated: March 2026

The Minnesota Medicaid fee schedule for 2026 lists what the state pays providers for covered health services.

It is published by the Minnesota Department of Human Services (DHS) as a 995-page document with thousands of procedure codes and payment rates.

This guide explains how to access the fee schedule, what has changed for 2026, and who can use these services.

Quick Summary

• The official 2026 fee schedule is titled “Current Fee Schedule as of 02/10/2026” and covers all fee-for-service (FFS) codes.
• Long-term care services got a 6.013% rate increase for 2026.
• The fee schedule applies only to FFS claims — not managed care plans.
• You can look up any procedure code using the official MHCP Fee Schedule Database.
• Income limits for Medical Assistance start at about $21,597 for a single person in 2026.
• Check your Minnesota Medicaid income limits in 2026 to see if you qualify.

What Is the Minnesota Medicaid Fee Schedule?

The Minnesota Medicaid fee schedule is the state’s official list of maximum payment rates for health care services.

The Minnesota Department of Human Services (DHS) manages it as part of Minnesota Health Care Programs (MHCP).

Providers use this schedule to know how much the state will pay for each covered service.

What the Fee Schedule Covers

The fee schedule includes rates for physician visits, outpatient care, lab work, durable medical equipment, ambulance services, and other professional services.

Each code has fields for the total allowable amount, technical and professional components, prior authorization indicators, and effective dates.

What the Fee Schedule Does Not Cover

The fee schedule does not include managed care capitation payments, most hospital inpatient rates, or all institutional rates.

If a patient is enrolled in a Managed Care Organization (MCO) like Blue Plus, UCare, or HealthPartners, that insurer sets its own rates.

Nursing facility rates also follow a separate Patient-Driven Payment Model (PDPM) and are not part of the main FFS fee schedule.

How to Access the 2026 Minnesota Medicaid Fee Schedule

The complete 2026 fee schedule is available for free from the DHS website. There is no single “annual” document — the state updates one master file throughout the year.

The current version is 995 pages long and dated 02/10/2026.

Download the Full Fee Schedule (PDF or Excel)

1. Go to the MHCP Fee Schedule index page.
2. Accept the required CPT/CDT license agreement.
3. Download the PDF or Excel version of the current fee schedule.

The PDF is available at: https://mn.gov/dhs/assets/mhcp-fee-schedule_tcm1053-294225.pdf.

Use the Online Lookup Tool

You can also search for specific codes using the MHCP Fee Schedule Database:

1. Enter a Date of Service in 2026 (e.g., 01/01/2026).
2. Enter the CPT or HCPCS code you need (e.g., 99213 for an office visit).
3. Add any required modifiers (some dental and telehealth codes need them).
4. View the allowed rate for that code.

Understanding the Fee Schedule Columns

The schedule includes these key columns:

Who Qualifies for Minnesota Medicaid in 2026?

Minnesota Medicaid (Medical Assistance) covers low-income adults, children, pregnant women, seniors, and people with disabilities.

Your eligibility depends on your income, household size, and category.

You can learn more about Medicaid eligibility in 2026 across different groups.

2026 Income Limits for Medical Assistance and MinnesotaCare

These income limits determine who can access services billed under the fee schedule. They took effect January 1, 2026.

Income is based on Modified Adjusted Gross Income (MAGI). These figures come from the Minnesota DHS. For a full state-by-state comparison, see Medicaid income limits by state in 2026.

Long-Term Care Asset Limits

For long-term care Medicaid, asset limits also apply. In 2026:

• Single applicant asset limit: $3,000
• Community Spouse Resource Allowance: Up to $162,660 in assets the non-applicant spouse can keep
• Monthly Maintenance Needs Allowance: Up to $4,066.50 per month for the community spouse

Key 2026 Rate Changes in the Minnesota Medicaid Fee Schedule

Several important rate updates took effect for 2026. These changes affect how much providers get paid for specific services.

Understanding these updates helps you know what to expect from Medicaid fee schedules in 2026.

Long-Term Services and Supports (LTSS) Rate Increases

Effective January 1, 2026, the DHS applied these increases:

• 6.013% increase to Alternative Care (AC) and Elderly Waiver (EW) monthly case mix budget caps
• 6.013% increase to consumer-directed community supports (CDCS) budgets under AC/EW
• 6.013% increase to EW customized living and 24-hour customized living daily and monthly limits
• 6.34% increase to home-delivered meals
• 2.7% increase to environmental accessibility adaptations (EAA)
• 1.67% increase to Essential Community Supports (ECS) budget caps

These LTSS rates are set through separate frameworks and are not listed in the main MHCP fee schedule PDF.

Adult Mental Health Services

The Critical Access Mental Health rate add-on dropped to 5.92% for 2026. This applies to eligible mental health clinics, centers, and essential community providers. Full FFS rates for mental health services remain in the main fee schedule.

Dental Services

Dental rates include a base fee plus a 98% add-on for services provided on or after January 1, 2022. This rule still applies in 2026 unless new legislation changes it. Payment rates for state-operated clinics and Indian Health Services (IHS) may differ.

Medicare Connection for Physician Services

Minnesota Medicaid often uses Medicare benchmarks. The 2026 Medicare Physician Fee Schedule conversion factor saw about a 3.3% increase over 2025. Providers should check if DHS adopts similar changes for dual-eligible claims.

Fee-for-Service vs. Managed Care: Which Fee Schedule Applies?

This is one of the most important distinctions for providers and patients. The DHS fee schedule applies only to Fee-for-Service (FFS) members. Understanding which payment system covers you determines which rates apply.

Fee-for-Service (FFS)

If you receive Medicaid through FFS, the state pays your provider directly using the MHCP fee schedule rates. You can look up exact rates using the tools above.

Managed Care (Prepaid Medical Assistance Program — PMAP)

If you are enrolled in a Managed Care Organization (MCO), your insurer negotiates its own rates with providers. Common MCOs in Minnesota include:

• Blue Plus
• UCare
• HealthPartners

These MCO rates may be higher or lower than the state FFS schedule. Always verify your coverage type before assuming which rates apply.

Important 2026 Policy Changes Affecting the Fee Schedule

Beyond rate numbers, several policy updates affect how and whether claims get paid in 2026. Providers and patients should be aware of these changes.

Federal Funding and Fraud Oversight

As of March 2026, Minnesota is navigating a dispute with federal authorities over Medicaid funding deferrals linked to fraud concerns. This means stricter scrutiny on claims.

Some provider types — especially certain HCBS and transportation providers — face enrollment freezes and tighter revalidation requirements.

New Medicaid ID Cards

Minnesota is transitioning members to redesigned ID cards in 2025–2026. Providers must verify eligibility using the new card format. This ensures the fee schedule applies to the current coverage period.

Nursing Facility Rate Methodology

Nursing facilities use a blended payment model for 2026: 75% RUG-IV and 25% PDPM through December 2026. These rates are separate from the main MHCP fee schedule.

Home and Community-Based Services (HCBS) Changes

Personal Care Assistance (PCA) continues to transition toward Community First Services and Supports (CFSS).

This affects how HCBS fees are billed and reimbursed. Governor Walz’s administration has proposed changes to simplify HCBS administration.

What Does Medicaid Cover in Minnesota?

Minnesota Medicaid covers a wide range of health services. The fee schedule lists payment rates for most of these.

Here is what Medical Assistance typically covers:

• Doctor visits and preventive care
• Hospital inpatient and outpatient services
• Prescription drugs
• Mental health and substance use treatment
• Dental care (with the 98% add-on)
• Vision and hearing services
• Lab tests and X-rays
• Durable medical equipment
• Ambulance and transportation
• Home and community-based services
• Long-term care and nursing facility services
• Personal care assistance

Coverage details can vary by program (MA vs. MinnesotaCare) and by managed care plan.

How to Apply for Medicaid in Minnesota

If you think you qualify based on the income limits above, here is how to apply for Medical Assistance or MinnesotaCare.

1. Visit MNsure online at mnsure.org to start an application.
2. Call MNsure at 1-855-366-7873 for help over the phone.
3. Contact your county human services office to apply in person.
4. Gather your documents. You will need proof of income, ID, and household information.
5. Submit your application. You can apply any time — there is no limited enrollment period for Medicaid.
6. Wait for a decision. The state must respond within 45 days (90 days for disability-based cases).

What Happens After You Apply?

After you submit your application, the state reviews your income and household details. Most decisions come within 30 to 45 days. Here is what to expect.

Eligibility Determination

The state checks your Modified Adjusted Gross Income (MAGI) against the current Federal Poverty Level (FPL) guidelines. If you qualify, you receive a Medicaid card and a notice showing your coverage start date.

If You Are Approved

Your coverage may start as early as the date you applied. You can begin using services billed under the fee schedule right away. If you are assigned to a managed care plan, your MCO will send you a separate member packet.

If You Are Denied

You have the right to appeal. The denial notice will explain why and how to request a hearing. You can also reapply if your situation changes.

FAQ

Sources & Disclaimer

Last Updated: March 2026

Sources:

• Minnesota Department of Human Services — MHCP Fee Schedule (PDF)
• Minnesota Department of Human Services — MHCP Fee Schedule Index
• Minnesota Department of Human Services — LTSS Rate Changes
• Minnesota Department of Human Services — Adult Mental Health Service Rates
• Medicaid.gov
• Healthcare.gov — Medicaid & CHIP

Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official eligibility, contact your state Medicaid office or visit Medicaid.gov.