MedicaidReimbursementMedium impact
PACE Payment Rates for Calendar Year 2026
Maryland Medicaid·MD · Geriatrics·PACE
Effective date
Jan 1, 2026
We identified it
Jul 17, 2026
Summary
Maryland Department of Health has updated PACE (Program of All-Inclusive Care for the Elderly) capitation payment rates for calendar year 2026, effective January 1, 2026. Rates vary by age group (55-64 and 65+), dual eligibility status, and geographic region (Baltimore Metro vs. Washington Metro). Billing teams must verify correct rate application for claims and ensure their systems reflect these new rates.
Action Required
By December 31, 2025: Billing team must update PACE rate tables in billing software with the new CY 2026 rates. Verify that the system applies correct rates based on: (1) member age group (55-64 or 65+), (2) dual eligibility status (Medicaid Only or Full Dual), and (3) geographic region (Baltimore Metro or Washington Metro). Contact PACE organizations to confirm member assignments to correct rate categories. Update any internal rate reference documents. Communicate new rates to coding and claims processing staff to prevent underbilling or overpayment. Failure to update rates may result in incorrect reimbursement and compliance issues.