Maine Medicaid, known as MaineCare, is facing a significant funding shortfall, which may lead to delays or reductions in payments to healthcare providers. The Maine Department of Health and Human Services (DHHS) has announced plans to temporarily withhold certain payments starting March 12, 2025, if the Legislature does not pass a $121 million supplemental budget to address the $118 million funding gap.
Planned Payment Holds:
Critical Access Hospitals: Will receive only 70% of their normal prospective interim payments.
Hospital Claims: Payments for claims over $50,000 will be held.
Large Retail Pharmacies and Durable Medical Equipment Suppliers: Payments will be held.
Out-of-State Providers: Payments for hospital, ambulance, pharmacy, and durable medical equipment services will be held.
These measures are intended to ensure some level of funding is available for the remainder of the fiscal year. If the budget stalemate continues, further payment holds may be implemented starting the week of March 26, using a "first in, first out" approach based on submission date and time, up to a weekly claims cap.
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