MedicaidReimbursementMedium impact
2025.78 - Out-of-State and Border Hospital Reimbursement-Effective 01.01.2026
Connecticut Medicaid (HUSKY Health)·CT·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid has updated reimbursement rates for out-of-state and border hospitals effective January 1, 2026. The APR-DRG base rate increased to $7,505.68 for inpatient services and the APC conversion factor is now $71.76 for outpatient services.
Action Required
By January 1, 2026: Billing team must update billing system with new Connecticut Medicaid rates for out-of-state hospital services - APR-DRG base rate $7,505.68, behavioral health per diem $1,050.00, rehabilitation per diem $1,370.00, and APC conversion factor $71.76. Reference Provider Bulletin 2025-77 for adjustment factors and APR-DRG weights. Verify practitioners are enrolled in professional billing groups for hospital-based services.