Attention Providers: Temporary MaineCare Payment Holds

On February 26, 2025, we announced that, absent emergency action by the Legislature, the Department would need to temporarily hold certain provider payments beginning with the payment cycle that will run on March 12, 2025. As of the time of this message, the Legislature has not approved the necessary funding to avoid these measures.

For the payment cycles that will run on March 12 and, if necessary, March 19, the Department plans to take only the following actions:

  • 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 large retail pharmacies and large durable medical equipment suppliers; and
  • Hold payment for out-of-state providers of hospital, ambulance, pharmacy, and durable medical equipment services.

During the March 12 and 19 payment cycles, other payments will process as they normally would.

During the week of March 17, we will send another communication regarding the plan for the payment cycle that will run on March 26. The Department anticipates the March 26 cycle will need to also include a temporary hold on payments beyond those listed above, using a “first in first out” payment approach based on date and time of submission, up to a weekly aggregate claims cap. Under this approach, 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 dependent in part on any 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. 

Based on the complexity of this work, the continuing work of the Legislature, and our ongoing refinement of FY25 budget projections, the current plans to temporarily hold certain payments, including which providers are impacted, are subject to change.

 

As a reminder, the Department and Administration does not independently have authority to access available funding that could address this shortfall and the significant and concerning impact of temporarily holding payments. The Legislature will need to take bipartisan action if funding is to be fully restored, and the Department urges legislators to identify a path as soon as possible to limit these unfortunate consequences.

We will share additional information as we are able.