Attention MaineCare Providers: Status of Temporary MaineCare Payment Holds

On March 5, 2025, MaineCare announced the Department would need to temporarily hold certain provider payments beginning with the payment cycle that ran on March 12, 2025.  As of the time of this message, the Legislature has not approved the necessary funding, by way of an emergency supplemental budget, to avoid these measures.

For the payment cycle that will run on March 26 we will continue to take only the following actions, consistent with the approach for the March 12 and March 19 payment cycles: 

  • Pay Critical Access Hospital prospective interim payments (PIPs) at 70 percent the normal levels; 
  • Hold payment for all hospital claims greater than $50,000; 
  • Hold payment for multi-state chain, large health system, and out-of-state retail pharmacies and durable medical equipment services; and 
  • Hold payment for out-of-state providers of hospital, ambulance, pharmacy (excluding pharmacies within 15 miles of the Maine border), and durable medical equipment services. 

The current approach to temporarily holding certain payments, including what kinds of providers are impacted, is subject to change given the complexity of this work, the continuing work of the Legislature, and our ongoing refinement of FY25 budget projections. The Department plans, to the extent it is able, to protect providers who are the most dependent on MaineCare revenue.

We do not yet have information about when we will be able to release held payments. The timing is largely dependent on the action by the Legislature. 

Consistent with state and federal requirements, providers may not bill, demand, or otherwise seek payment from MaineCare members (or a representative of the member) in order to provide for any MaineCare covered service, with the exception of copayments. Pursuant to MaineCare Benefits Manual Ch 1 Section 1.09-1(B), no provider may deny services to a member for failure to pay a copayment.   

We will provide an update for the payment cycle that will run on April 2 next week. If the Legislature takes emergency action this week to allow funding to be fully restored, the Department will send an update as soon as possible.