Back to dashboard
MedicaidReimbursementLow impact

2026 Critical Access Pharmacy (CAP) Program Payments

Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Days to comply
—

Summary

Effective January 1, 2026, the Illinois Critical Access Pharmacy (CAP) program will change from quarterly payments to point-of-sale dispensing fees of $21.05 for both HealthChoice Illinois MCO claims and Fee-for-Service claims (pending CMS approval). Final quarterly payments for 2025 will be released through April 2026.

Action Required

Action needed
No action required for medical billing teams. This policy change affects pharmacy dispensing fees and payment administration only. Pharmacies should continue billing FFS claims at $15.55 until further notice regarding SPA approval.

Related policy hubs