2026 Medicaid Updates Every Practice Must Know: Fee Schedules, Telehealth & Enrollment Tips

Medicaid updates have happened quietly, often buried in state notices and technical bulletins. In 2026, these updates become harder to ignore as they affect day-to-day operations and cash flow. Payment rates are becoming publicly visible, virtual care rules are settling into long-term patterns, and enrollment accuracy is now directly tied to payment continuity. These shifts mean Medicaid can no longer be treated as a static payer or an afterthought. Practices that understand how fee schedules, telehealth policies, and enrollment requirements are evolving will be better positioned to protect revenue and avoid disruption.

This blog outlines the key Medicaid updates for 2026 and what every practice needs to know to stay prepared and compliant.

Medicaid Fee Schedules in 2026

In 2026, Medicaid fee schedules are becoming more visible and are being reviewed more closely. Federal transparency requirements now require states to publish payment rates and compare them with Medicare rates clearly. As a result, Medicaid reimbursement is easier to analyze and harder for practices to overlook.

• Stronger Oversight of Payment Adequacy

Federal oversight in 2026 places greater emphasis on whether Medicaid payment levels support provider participation and patient access. Medicaid often reimburses 30% to 40% less than Medicare, and this gap is now receiving increased scrutiny from regulators and policymakers.

• Public Medicaid Fee Schedules

States must publish complete Medicaid fee-for-service rate schedules online by July 1, 2026. These rates must be accessible and regularly updated, allowing practices to clearly see reimbursement amounts without relying on payer notices or informal guidance.

• Medicaid and Medicare Rate Comparisons

States are required to publish formal comparisons between Medicaid and Medicare payment rates. These comparisons highlight services with large reimbursement gaps and may influence future rate evaluations, particularly for services tied to provider shortages or access challenges.

• Payment Differences by Care Setting

Medicaid payment approaches increasingly reflect where care is delivered. Office-based and non-facility services may experience more stable reimbursement than facility-based services. However, the financial impact continues to vary based on each state’s Medicaid payment methodology.

Medicaid Telehealth in 2026

Telehealth remains an essential care option in Medicaid during 2026, but rules continue to differ by state. Practices must understand which services are covered, how they are reimbursed, and what documentation is required to avoid denials or reduced payments.

• State-Controlled Telehealth Policies

Medicaid telehealth policies are set at the state level rather than nationally. Each state defines eligible services, providers, and billing requirements. This results in significant variation, especially among practices that deliver care across multiple Medicaid programs.

• Services with Stable Telehealth Coverage

Behavioral and mental health services continue to receive broad telehealth support across Medicaid programs. Many states also cover telehealth for chronic care management and follow-up visits, supporting access for a population that represents nearly 25% of U.S. residents.

• Coverage Versus Payment Parity

Most states cover telehealth services, but fewer guarantee equal payment compared to in-person care. Only about half of U.S. states require Medicaid payment parity, meaning approved telehealth visits may still be reimbursed at lower rates.

• Telehealth Documentation Requirements

Medicaid programs continue to closely monitor telehealth utilization. Practices must document medical necessity, visit modality, patient location, and consent. Many states also apply visit frequency limits and utilization reviews to manage telehealth spending.

Medicaid Enrollment in 2026

Medicaid enrollment has become a critical revenue safeguard in 2026. With payment data publicly visible, states are placing stronger emphasis on accurate provider records. Even small enrollment errors can lead to delays, denials, or payment interruptions.

• Increased Enrollment Scrutiny

States are strengthening enrollment reviews to ensure provider data is complete and accurate. This includes ownership information, practice locations, and provider classifications. Inaccurate enrollment data can now trigger compliance issues or disrupt reimbursement.

• Extended Enrollment Timelines

Medicaid enrollment and revalidation typically take 90 to 180 days, depending on the state. Delays often occur when information does not align across CAQH, PECOS, and state Medicaid systems, making early preparation essential.

• Common Enrollment Errors

Frequent enrollment issues include incorrect NPIs, outdated addresses, missing disclosures, and incomplete ownership details. Even after approval, claims may be rejected if enrollment data is not correctly connected to billing and payer systems.

• Post-Approval Payment Setup

Enrollment approval alone does not ensure payment. Practices must complete EFT and EDI setup to receive funds and submit claims. Testing claims early helps confirm systems are correctly configured before complete billing begins.

What Practices Should Do to Prepare for 2026 Medicaid Changes

• Review newly published Medicaid fee schedules and compare them with Medicare rates to identify underpaid services.
• Verify Medicaid telehealth coverage and payment rules at the state level before billing.
• Start Medicaid enrollment and revalidation well ahead of provider start dates.
• Ensure provider data is consistent across CAQH, PECOS, and state Medicaid portals.
• Complete EFT and EDI enrollment promptly after approval.
• Test claims early to prevent payment delays and cash flow disruptions.

How Outsourcing to 24/7 MBS Strengthens Medicaid Readiness in 2026

Keeping up with Medicaid changes in 2026 is becoming increasingly complex as states publish fee schedules, tighten telehealth oversight, and apply stricter enrollment controls. 24/7 Medical Billing Services helps practices interpret these updates accurately by tracking state-level Medicaid policies, identifying reimbursement risks, and aligning billing workflows with current rules. This proactive approach reduces denials, minimizes payment delays, and ensures practices respond quickly to policy changes without disrupting operations.

Outsourcing medical billing and coding services to 24/7 MBS provides operational stability and financial clarity. In fact, their team supports end-to-end revenue cycle management from managing provider enrollment and revalidation to optimizing telehealth and Medicaid claim submissions. Therefore, practices can safeguard revenue, adapt confidently to 2026 Medicaid requirements, and dedicate more time to delivering quality patient care by leveraging specialized expertise and continuous monitoring.

FAQs

Do Medicaid fee schedule changes apply uniformly across all states in 2026?

No, Medicaid rates remain state-specific, with each program determining payment levels and update timing.

Will Medicaid telehealth rules automatically match Medicare policies in 2026?

No, Medicaid telehealth coverage and payment rules are set independently by each state.

Are audio-only telehealth visits still allowed under Medicaid in 2026?

Some states allow audio-only services, but coverage varies by service type and location.

How often must Medicaid providers revalidate enrollment in 2026?

Revalidation typically occurs every five years, though states may request updates sooner.