Attention MaineCare Providers: Status of Temporary MaineCare Payment Holds – April 3, 2025
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.
At this time, the current payment withholding approach will continue unless further emergency action is taken by the legislature to make funds available sooner. The situation remains fluid, and we are closely monitoring projections to inform decisions.
For upcoming payment cycles, we will continue to take only the following actions unless we communicate otherwise, consistent with the approach to the previous 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 (excluding those within 15 miles of the Maine border); and
- Hold payment for out-of-state providers of hospital and ambulance services.
We remain committed to keeping providers informed as plans are updated. If the current withholding approach needs to change or if there are other relevant developments, we will send a communication out as soon as possible.
We are still determining when we can begin to release held provider payments. We will share plans for releasing held claims when we have more information.
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.