Nebraska Medicaid Fee Schedule 2026

Last Updated: April 28, 2026

Nebraska Medicaid fee schedules for 2026 set the exact payment rates for doctors, hospitals, pharmacies, and other providers.

These rates are managed by the Nebraska Department of Health and Human Services (DHHS) and run from July 1, 2025 through June 30, 2026.

Knowing these rates helps providers get paid correctly and helps patients understand their covered services.

Quick Answer Summary:

• Nebraska Medicaid 2026 rates are set under State Plan Amendment NE 25-0013
• Physician rates updated July 1, 2025, with a revised increase effective January 1, 2026
• The federal reimbursement rate (FMAP) dropped to 55.94% for FFY 2026
• Pharmacy dispensing fees rose to $10.50 per prescription as of July 1, 2025
• ABA therapy rates were cut up to 79% effective August 1, 2025
• All official fee schedules are free to download at dhhs.ne.gov

What Is the Nebraska Medicaid Fee Schedule?

The Nebraska Medicaid fee schedule is an official list of payment rates. It tells providers exactly how much Medicaid will pay for each service.

Nebraska Medicaid uses two delivery systems for these payments:

1. Managed Care — Most services go through Heritage Health, which includes three health plans.
2. Fee-for-Service (FFS) — Used mainly for long-term care and specialty services.

How Payment Is Calculated

Medicaid always pays the lower of these two amounts:

• The provider’s submitted charge, OR
• The approved fee schedule rate

This protects the program from overpaying for services.

Fee Schedule Update Cycle

Nebraska updates its fee schedules on two different cycles:

Nebraska Medicaid FMAP Rate for 2026

The Federal Medical Assistance Percentage (FMAP) sets how much the federal government pays Nebraska back for Medicaid spending.

Here are Nebraska’s FMAP rates for Federal Fiscal Year (FFY) 2026:

Nebraska saw one of the largest FMAP decreases in the country — about 3.16 percentage points less than last year. This means Nebraska must cover a bigger share of Medicaid costs in 2026.

For state budget planning, Nebraska uses a blended FMAP of 57.15% for SFY 2026.

Nebraska Medicaid Physician Fee Schedule 2026

Physician and practitioner services follow the Nebraska Medicaid Physician Fee Schedule. This is one of the most important rate tables for medical providers.

The current physician fee schedule is effective July 1, 2025. A revised schedule was posted on January 1, 2026 with higher rates.

What Changed in January 2026

Nebraska DHHS increased rates for several service types:

• ✅ Evaluation and management (E&M) services
• ✅ Labor and delivery services
• ✅ Rural provider services

The estimated cost of these increases:

• Total cost (FFY 2026): $116,029
• Federal funds: $75,338
• General (state) funds: $40,691

Site-of-Service Differential

Nebraska follows the Medicare site-of-service rule. This means payment may be lower when a service is performed in a hospital setting versus an office setting.

Out-of-State Physicians

Out-of-state doctors can receive negotiated rates only for services not available in Nebraska. Examples include:

• Lung transplants
• Pediatric heart transplants

Outpatient Hospital and ER Services 2026

Nebraska Medicaid pays for outpatient hospital services using a cost-to-charges ratio formula.

For services on or after July 1, 2025, payment equals:

93% × Cost-to-Charges Ratio × Submitted Charges

This is based on the hospital’s most recent Medicare cost report.

Critical Access Hospitals (CAHs)

Critical Access Hospitals receive special treatment. They are reimbursed at:

100% of reasonable cost of providing the service

This higher rate helps small rural hospitals stay open and serve their communities.

Telehealth Services

Good news for patients using telehealth:

Nebraska Medicaid pays the same rate for telehealth as for in-person visits.

If you use telehealth to see your doctor, your provider is paid the same amount.

Clinical Lab Fee Schedule 2026

Nebraska Medicaid pays for clinical lab tests at 100% of the Medicare Clinical Laboratory Fee Schedule. These rates are updated every time CMS (the federal agency) updates Medicare lab rates.

The January 1, 2026 Clinical Lab Fee Schedule has been officially posted on the DHHS portal.

Injectable Medications and Immunizations 2026

Injectable drugs are reimbursed at 100% of the Medicare Drug Fee Schedule. Nebraska updates these rates every quarter when CMS releases new Medicare rates.

2026 Injectables Schedule

Immunizations Now Have Their Own Schedule

Starting January 1, 2026, Nebraska Medicaid created a separate fee schedule just for immunization and vaccine codes. Before this change, vaccine codes were listed on the injectables schedule.

An April 2026 immunization fee schedule has also been published.

Dental Services Fee Schedule 2026

Nebraska Medicaid covers dental services for eligible members. Payment is the lower of:

• The provider’s submitted charge, OR
• The allowable amount in the Dental Fee Schedule

The January 2026 Dental Services Fee Schedule is available on the DHHS portal. You can also check the Medicaid Fee Schedule in 2026 for a broader look at how dental rates compare across programs.

Pharmacy Dispensing Fees 2026

Pharmacies play a key role in Medicaid. Nebraska updated pharmacy dispensing fees on July 1, 2025.

This increase applies to both fee-for-service and managed care prescriptions.

Long-Term Care Pharmacies

Pharmacies serving nursing homes and intermediate care facilities receive:

One dispensing fee per month per prescription (not per refill)

This special rule helps control costs in long-term care settings.

Preferred Drug List (PDL)

Nebraska posts monthly updates to its Preferred Drug List (PDL). As of March 2026, the PDL reflects changes effective through March 2, 2026.

Durable Medical Equipment (DME) Rates 2026

DME includes wheelchairs, walkers, oxygen equipment, and other medical supplies. Nebraska Medicaid pays the lowest of these three amounts:

1. Medicare DMEPOS fee schedule rate for Nebraska
2. Medicare competitive bidding program rate
3. Provider’s billed charges

DME rates are updated quarterly when CMS updates Medicare rates.

Other Practitioner Fee Schedules (SFY 2026)

Nebraska Medicaid covers a wide range of services. Here is a full list of service-specific fee schedules for SFY 2026 (July 2025–June 2026):

FQHC and Rural Health Clinic Rates 2026

Federally Qualified Health Centers (FQHCs) serve low-income communities. They receive payments through the Prospective Payment System (PPS). This is based on the cost per visit.

Nebraska Nursing Facility Rates 2026

Nursing facilities caring for Medicaid patients receive updated rates each year. For SFY 2026 (July 1, 2025–June 30, 2026), Nebraska applied an inflation factor of 1.49% to nursing facility rates.

Estimated Budget Impact

💡 Nursing facility services remain in the fee-for-service system, not managed care.

Quality Incentive Add-Ons

Nebraska rewards quality care with daily add-on payments based on CMS star ratings:

Nebraska’s proposed total nursing facility appropriation for FY 2026–27: $462,480,546.

Assisted Living Facility (ALF) Rates 2026

Assisted living facilities serve seniors and people with disabilities. Nebraska posted updated ALF rates effective January 1, 2026.

Monthly Assisted Living Rates (January 2026)

Daily ALF Rates

Daily Medicaid rates range from:

• $45.73/day — Rural, multiple occupancy
• $73.91/day — Urban, single occupancy

⚠️ Important Note on LB57 Rate Increase

Nebraska’s LB57 proposed raising daily ALF rates to:

• $88.24/day (FY 2026)
• $91.78/day (FY 2027)

As of April 2026, it has NOT been confirmed whether LB57 was enacted. Providers should verify current rates directly with Nebraska DHHS before billing.

ICF/DD Inflation Factor 2026

For Intermediate Care Facilities for people with Developmental Disabilities (ICF/DD), Nebraska applied an inflation factor of 24.85% for SFY 2026.

This large inflation adjustment reflects rising costs for serving individuals with developmental disabilities.

ABA Therapy Major Rate Cut (Effective August 1, 2025)

One of the biggest Medicaid changes in Nebraska for 2026 was a major cut to Applied Behavior Analysis (ABA) therapy rates. These cuts took effect August 1, 2025 and carry through all of SFY 2026.

Why Did Nebraska Cut ABA Rates?

Nebraska’s ABA Medicaid spending exploded in recent years:

• 2020: $4.6 million
• 2024: $85.6 million
• Growth: 📈 1,750% increase in 4 years

Nebraska’s pre-cut rates were the highest in the nation — more than double the national average for some codes. DHHS said the new rates are still competitive with neighboring states.

ABA Rate Comparison: Before vs. After

Real-World Impact (March 2026)

A March 2026 analysis found serious consequences from the ABA cuts:

• 🏥 Several ABA providers closed or reduced services
• 👨‍👩‍👧 Rural families faced major access challenges
• 📉 Fewer children could get timely ABA therapy

DHHS maintained the cuts were necessary for the long-term sustainability of the Medicaid program.

New Medicaid Programs in 2026

Nebraska expanded its Medicaid program with several important new services in 2026.

1. Certified Community Behavioral Health Clinics (CCBHC)

Effective January 1, 2026, Nebraska Medicaid launched the CCBHC program. It covers:

• Mental health evaluation and treatment
• Substance use disorder (SUD) services
• Crisis response services
• Primary care screening
• Targeted case management
• Peer and family support services

Estimated FFY 2026 cost: $91,594 ($68,396 federal / $23,198 state)

2. Justice-Involved Youth Services

Effective January 1, 2025 (continuing into SFY 2026), Nebraska Medicaid covers services for young people leaving the justice system. This includes:

• Screenings and diagnostics
• Targeted case management
• Services starting 30 days before release through 30+ days after release

Estimated FFY 2026 cost: $900,000

3. Postpartum Home Program (PHP)

Starting July 1, 2026, Nebraska Medicaid will provide:

• In-home nurse case management for new mothers
• Support for newborns up to 12 months old

Estimated FFY 2027 cost: $129,844

4. Postpartum Services Extension

Effective October 1, 2025, Nebraska extended postpartum Medicaid coverage:

From 60 days ➡️ to 12 months after pregnancy ends

This is a major improvement for maternal health in Nebraska.

5. Section 1115 Sustainable Coverage Waiver

In February 2026, Nebraska filed a 5-year Section 1115 waiver to limit retroactive Medicaid eligibility.

• Anticipated start date: October 1, 2026
• Still pending CMS federal review as of April 2026

Who Qualifies for Nebraska Medicaid?

To receive Medicaid services in Nebraska, you must meet income and eligibility rules. Income limits vary by household size and program type.

To check if you qualify, use our free Medicaid Eligibility Calculator in 2026 — it gives you a fast answer based on your income and family size.

You can also compare income limits across all 50 states with our guide on Medicaid Income Limits by State 2026.

Where to Find Nebraska Medicaid Fee Schedules

All current Nebraska Medicaid fee schedules are available on the official DHHS portal. Providers can download Excel files for each service category.

Tip: Always download rates directly from the DHHS portal. Never rely on third-party rate lists, as they may be outdated.

Key Data Gaps to Know (April 2026)

Some fee schedule details are not yet confirmed. Here is what providers should be aware of:

Frequently Asked Questions (FAQs)

Last Updated: April 28, 2026
Source: Nebraska DHHS Division of Medicaid and Long-Term Care | Official DHHS Fee Schedule Portal