Attention Pharmacy Providers: Temporary MaineCare Payment Holds
On April 13, 2026, we announced that the Department will need to temporarily withhold certain MaineCare payments to some providers through the end of the fiscal year, (which ends June 30, 2026). While additional funding was approved by the Legislature and signed into law in the recent supplemental budget (Public Law 2025 Ch. 650), this funding is not available until the next fiscal year, (which begins July 1, 2026).
For the payment cycles that will run on May 13, 2026, through June 30, 2026, the Department plans to temporarily withhold payment for multi-state and large health system chain pharmacies and out-of-state retail pharmacies.
MaineCare will hold claims for these pharmacies during the weekly financial cycle as part of our temporary hold on certain provider payments. Independent pharmacies located in New Hampshire towns within 15 miles of the Maine border will continue to be paid.
Pharmacy claims will continue processing as normal in Maine Point of Purchase System (MEPOPS). Claims will show as Paid in MEPOPS, which is an indication that MaineCare will reimburse the provider for those claims; however, the payments will not be released for payment processing until funds are available. Pharmacies will know if their claims are temporarily held because pharmacies will not receive a Remittance Advice (RA) if their claim is not paid.
Please refer to the information shared in our April 13, 2026 e-message for more information.
Consistent with state and federal requirements, providers may not bill, demand, or otherwise seek payment from MaineCare members (or a representative of the member) to provide for any MaineCare covered service, with the exception that they may ask for copayments. However, 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.
We do not yet have information about when we will be able to release held payments but anticipate it will be in early July. We will share additional information as we are able.