Plans to Release Payments Pended During Temporary 2026 MaineCare Payment Holds

On April 13, 2026, the Department shared that it would temporarily hold certain MaineCare provider payments beginning with the payment cycle that ran on May 13, 2026. Payment withholding has continued since then utilizing the approach outlined. In anticipation of receiving supplemental funding for Fiscal Year 2026 provided in Public Law 2025 Ch. 650, the Department is planning to release held provider payments and reinstate full provider payment operations starting this week.

For the upcoming payment cycle running on June 24, 2026, the Department will take the following actions: 

  • Pay Critical Access Hospital and private psychiatric hospital prospective interim payments (PIPs) amounts previously withheld; and
  • Revert to normal operations regarding pending and paying high-dollar hospital claims. 

Affected providers will be able to track the medical claim status of these previously held claims in the HealthPAS Online Portal, which reflected a “pend” status during the temporary payment withholding period. As the Department begins the process of releasing the held claims, providers will begin to see their claims move to a “waitpay” or “pay” status through June 24, 2026.

For the upcoming payment cycle running on July 1, 2026, the Department will take the following actions: 

  • Pay pended claims for multi-state chain, large health system, and out-of-state retail pharmacies and durable medical equipment services; and 
  • Pay pended claims for out-of-state providers of hospital and ambulance services. 

Pharmacies will see the relevant detail on their remittance advices. Reversals that have been pending during the temporary payment withholding period will process in the following cycle on July 1, 2026. This may cause the net July 1, 2026 payment to pharmacies to be lower than normal, reflecting the higher volume of reversal. Note the Department will require additional time in order to process a small minority (less than 3%) of pharmacy claims related to MaineCare’s Children’s Health Insurance Program (CHIP) that require additional intervention to ensure payment at the appropriate federal match amounts.

We remain committed to keeping providers informed. If the planned payment approach needs to change or if there are other relevant developments, we will send a communication out as soon as possible.