Attention Providers: Capping of MaineCare Payment Cycles

In January 2026, Governor Mills submitted a supplemental budget request to the Legislature that included additional baseline funding for the MaineCare program to align funding levels for the program with anticipated spending through the end of the current fiscal year (which ends June 30, 2026). While this additional funding was approved by the Legislature and signed into law in the recent supplemental budget (Public Law 2025 Ch. 650), this funding will not be available until next fiscal year. As a result, the Department will need to temporarily withhold certain MaineCare payments to some providers through the end of the fiscal year.

Beginning on the payment cycle that will run on May 13, 2026, through June 30, 2026, the Department will temporarily:

  • Withhold no more than 30 percent of the normal levels of Critical Access Hospital (CAH) and private psychiatric hospital prospective interim payments (PIPs). If the Department is able to withhold a lower percentage than 30%, we will notify hospitals prior to May 13 with the updated percentage;
  • Withhold payment for all high dollar hospital claims, defined as those greater than $50,000; 
  • Withhold payment for multi-state and large health system chain pharmacies and out-of-state retail pharmacies (excluding pharmacies within 15 miles of the Maine border);
  • Withhold payment for large chain and out of state durable medical equipment providers; and
  • Withhold payment for out-of-state providers of hospital and ambulance services. 

We do not yet have information about when we will be able to release held payments but anticipate it will be in early July.

These temporary payment withholdings are focused on the same providers and payments as the temporary withholding implemented at the end of FY25. This plan minimizes negative collective impact on providers, with an emphasis on protecting providers that are most dependent on MaineCare revenue. We will continue to monitor the projected shortfall throughout this fiscal year, and we will share information about any additional payment withholdings that may become necessary if current circumstances change substantially.

As a reminder, consistent with state and federal requirements, providers may not bill, demand, or otherwise seek payment from MaineCare members (or representatives of members) as a condition of providing a MaineCare covered service.