MedicaidReimbursementMedium impact
Changes to Cost Outlier Payment Calculation
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jan 1, 2008
We identified it
Jun 21, 2026
Summary
Illinois Medicaid changed cost outlier payment calculations effective January 1, 2008. For DRG-reimbursed hospitals, the Fixed Loss Threshold multiplier increased to 1.64, and per diem hospitals now use a 0.17 marginal cost payment factor. Children's hospitals can now receive outliers for patients through age 18.
Action Required
Hospital billing teams should update cost outlier calculation worksheets using new multipliers (1.64 for DRG, 0.17 for per diem). Replace Handbook pages H-22f as specified in the notice. Children's hospitals should adjust billing processes to claim outliers for patients up to age 18. The state will automatically adjust previously paid claims from January 1, 2008 forward.