Attention MaineCare Providers: Status of Temporary MaineCare Payment Holds

On March 5, 2025, the Department shared the plans to temporarily hold certain MaineCare provider payments beginning with the payment cycle that ran on March 12, 2025. On Friday, March 21, 2025, the Legislature passed a budget bill which appropriated funds sufficient to pay MaineCare providers in full through the end of the fiscal year. The budget did not gain the two-thirds support needed to be enacted on an emergency basis and take effect immediately. As such, the budget will not be effective until 90 days after the March 21 adjournment of the legislature; we anticipate funds will be available June 20. Unless further emergency action is taken by the legislature, payment holds will need to continue until then. We are still determining when we can begin to release held provider payments.  

At this time, the current payment withholding approach will continue. The situation remains fluid, and we are closely monitoring projections to inform week-to-week decisions. We remain committed to keeping providers informed as plans are updated. 

For the payment cycle that will run on April 2, we will continue to take only the following actions, consistent with the approach for the previous three 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 Department plans, to the extent it is able, to protect providers who are the most dependent on MaineCare revenue. We will provide an update next week for the payment cycle that will run on April 9.  

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.