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Effective January 1, 2026, MaineCare will update reimbursement rates for Medicare covered codes and services for the sections of policy noted below. The new rates will reflect 72.4% of the most recent 2026 Medicare rates.
Effective January 1, 2026, MaineCare is updating ASC rates to reflect 100% of current year Medicare rates.
Once new rates are implemented, MaineCare will provide adjustment billing guidance and post an updated fee schedule to the Rate Setting webpage of the Health PAS Online Portal.
Effective January 1, 2026, MaineCare will update ambulance service rates to reflect 100% of the most current Maine Medicare area 99 urban, rural, or super rural rates.
Effective January 1, 2026, MaineCare is updating DME rates to reflect 100% of current year Medicare rates.
Once new rates are implemented, MaineCare will provide adjustment billing guidance and post an updated fee schedule to the Rate Setting webpage of the Health PAS Online Portal.
Effective November 15, 2025, MaineCare implemented a temporary process to support member access to hearing aids when a provider determines a member is clinically eligible for a binaural hearing aid, but the member only meets MaineCare Benefits Manual (MBM), Chapter II, Section 60: Durable Medical Equipment and Section 109: Speech and Hearing Services coverage criteria for a monaural hearin
In a previous notice, the Office of MaineCare Services (OMS) reminded providers of their responsibility regarding third-party liability and secondary billing. Pursuant to MaineCare Benefits Manual (MBM) Ch. I Section 1.07-3(B), MaineCare is the payor of last resort.
Paper RAs
Starting the week of December 22, 2025, the Office of MaineCare Services (OMS) will no longer mail paper RAs to providers. This is a cost-saving initiative for the Department. We encourage you to reference the electronic PDF versions of the RAs posted on the Health PAS Online Portal. Advantages of using the PDF version include easier member and claim searching and access to previous RAs.
If your organization is going through an organizational change, please contact Gainwell to receive guidance before beginning an enrollment/revalidation/re-enrollment application or maintenance case and prior to submitting the Disclosure of Organizational Change for MaineCare form. This allows Gainwell/MaineCare to review the change and decide what is the best way the provider needs to enroll or update their enrollment.
Please contact the MaineCare Enrollment email box with questions.
It's not too late to vaccinate, take steps to prevent illness
AUGUSTA-- The Department of Health and Human Services' (DHHS') Maine Center for Disease Control and Prevention (Maine CDC) urges Mainers to take steps to protect their health as influenza (flu) activity begins to rise across Maine.
On December 15, 2025, we sent an e-message about all BHH Coordinators and Children’s Targeted Case Managers requirement to complete Wraparound Planning Principles (WPP) Training by January 31, 2026, as part of the Department of Justice Children’s Behavioral Health Services Settlement Agreement.
As follow up, please see the instructions for fulfill this requirement: