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Effective January 1, 2026, the MaineCare Orthodontia Pro-Rate Request Form is updated on the Manuals, Forms, and Criteria Sheets page of the Health PAS Online Portal.
This updated form reduces the administrative burden for providers and the Department when a prior authorization for Comprehensive or Limited Orthodontic treatment must be repriced because treatment stops before it is completed.
Jan 1, 2026
Tobacco use is the leading cause of preventable disease and death in Maine and the United States. It has major impacts on health care costs and lost productivity, affecting individuals, families, businesses, and the State.
MaineCare identified an error in the calculations for Section 65, cost-of-living adjustment (COLA) rates that were recently implemented with an effective date of January 1, 2026. The fee schedule also reflects this error.
Jan 1, 2026
On January 1, 2025, Maine implemented a comprehensive reform of nursing facility reimbursement rates through MaineCare to stabilize a sector under strain, strengthen the direct care workforce, improve quality, and ensure continued access to care for Maine’s older adults.
One year in, the results are encouraging, and the State is moving forward with confidence into 2026.
The Department identified an error in the capital cost calculations on the NF rate letters. Revised rate letters are now available on the secure Health PAS Online Portal.
Effective January 1, 2026, the MaineCare Orthodontia Pro-Rate Request Form is updated on the Manuals, Forms, and Criteria Sheets page of the Health PAS Online Portal.
This updated form reduces the administrative burden for providers and the Department when a prior authorization for Comprehensive or Limited Orthodontic treatment must be repriced because treatment stops before it is completed.
Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, January 1, 2026 Cost-of-Living Adjustment
NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment to increase reimbursement rates for the following sections by a 1% cost-of-living adjustment (COLA) which was appropriated by the Maine State Legislature.
As previously noticed, MaineCare is increasing RHC reimbursement rates to reflect a 1.0% COLA. We will implement these new rates by January 7, 2026, and adjust all affected claims. No provider action is required.
As previously noticed, MaineCare will update RCF direct care rates to reflect a 1.0% COLA. We will implement these new rates by February 1, 2026.
Effective January 1, 2026, updated rate letters are accessible on the secure Health PAS Online Portal.
For questions on these rates, please contact the individual listed on the rate letters.
As previously noticed, MaineCare will update NF direct care and routine rates to reflect a 1.0% COLA. We will implement these new rates by February 1, 2026.
Effective January 1, 2026, updated rate letters are accessible on the secure Health PAS Online Portal.
For questions on these rates, please contact the individual listed on the rate letters.