Free reference, nothing gated
Medicaid by state, all 50
Whether a state runs managed care or fee for service, which plans you will actually be billing, and the enrollment quirk that costs new practices the most time. Cited to the state agency on every row.
The first question when a practice takes on Medicaid in a new state is not what it pays. It is how many payers you are actually dealing with. A state running managed care means contracting, credentialing and billing each plan separately, and the number of plans ranges from one to more than a dozen depending on where you are.
The third column is the one worth reading. It is the state-specific rule that decides how long enrollment takes, and it is the part that is genuinely hard to find: whether the state credentials centrally or leaves it to each plan, whether there is one roster form or seven, and what else about that state catches people out.
Plan rosters change when a state re-procures. Several changed recently. Treat the plan names as a starting point and confirm against the linked source before making a contracting decision. This is a research summary, not enrollment advice.
| State | How Medicaid is delivered | What catches billers out | Timely filing (FFS) | Source |
|---|---|---|---|---|
| Alabama | Alabama runs essentially no capitated comprehensive MCOs — CMS's 2024 managed-care enrollment file shows Alabama's only managed care as PCCM entities: 'Alabama Coordinated Health Network (PCCM Entity)' with 811,224 enrollees, 'Integrated Care Network (PCCM Entity)' / Alabama Select Network with 26,388, and one PACE organization. Claims continue to be adjudicated fee-for-service by the state's fiscal agent while the seven regional ACHN entities do care coordination. | Alabama statutorily caps payer recoupment and hands the provider a second bite at the claim. Ala. Code 27-1-17(e): a payer 'shall not retroactively deny, adjust, or seek recoupment or refund of a paid claim ... other than fraud or coordination of benefits or for duplicate payments ... after the expiration of one year from the date that the initial claim was paid or after the expiration of the same period of time that the health care provider is required to submit claims pursuant to a contract ... whichever date occurs first' — 18 months where the reason is coordination of benefits (subsection (f)). Crucially, when a recoupment does happen, 'the health care provider shall have an additional period of six months from the date that the notice ... was received within which to file either a revised claim or a request for reconsideration with additional medical records or information.' Separately, 27-1-17(d)(2) turns the prompt-pay clock off entirely for any claim submitted more than 180 days after the service was rendered. | 1 year from the date of service | View |
| Alaska | Entirely fee-for-service — Alaska contracts with no comprehensive Medicaid MCOs (KFF 2024 MCO enrollment = N/A; "N/A: Not applicable. State had no contracts with comprehensive MCOs."), so there are zero health plans between the provider and the state. | Because of geography, Alaska Medicaid pays for patient travel as a covered benefit and devotes an entire regulatory article to it — 7 AAC 120 Article 3 contains "§ 7 AAC 120.405 - Transportation and accommodation covered services", "§ 7 AAC 120.410 - Prior authorization for nonemergency transportation services", "§ 7 AAC 120.425 - Accommodation services", "§ 7 AAC 120.430 - Authorized escort" and "§ 7 AAC 120.435 - Prematernal home services". Alaska billers routinely handle lodging, escort and air-travel authorizations that do not exist in most states. | not yet read | View |
| Arizona | AHCCCS (Arizona Health Care Cost Containment System) delivers Medicaid almost entirely through capitated contracted health plans under an 1115 waiver rather than paying providers directly; the Arizona Auditor General reported that 'as of May 2025, AHCCCS is responsible for completing performance reviews of 11 contracted health plans' across its ACC, ACC-RBHA, ALTCS and DDD lines. | AHCCCS timely filing is six months, not the 12 months common in other states. Ariz. Admin. Code § R9-22-703(B)(2) sets the initial-claim deadline at 'Six months from the date of service or for an inpatient hospital claim, six months from the date of discharge; or ... Six months from the date of eligibility posting.' A Medicaid A/R workflow tuned to a 12-month window will write off Arizona claims that were still collectible everywhere else. | 6 months from the date of service to submit; 12 months to be a clean claim | View |
| Arkansas | Mostly fee-for-service, with two carve-outs rather than general MCOs: the PASSE program (provider-led risk-bearing entities; the DHS fact sheet states 'There are four organizations in Arkansas that follow the PASSE model') covers only high-need behavioral-health and IDD beneficiaries, while Medicaid expansion adults are covered through ARHOME premium assistance into commercial Marketplace plans. | Arkansas buys private commercial coverage for its Medicaid expansion population instead of enrolling them in Medicaid managed care: 'The State proposes to continue to provide premium assistance to purchase coverage offered by Qualified Health Plans (QHPs) that participate in the individual insurance Marketplace in Arkansas.' Practically, an ARHOME patient presents a commercial QHP card and the claim is billed to that carrier under commercial rules, not to Arkansas Medicaid — so eligibility checks that stop at the Medicaid portal will mis-route the claim. | not yet read | View |
| California | Medi-Cal is overwhelmingly managed care: DHCS describes members in all 58 counties receiving care through five managed care models — Two-Plan, County Organized Health Systems (COHS), Geographic Managed Care (GMC), Regional Model, and Single-Plan — so which plan(s) a biller deals with depends entirely on the county's model; a fee-for-service Medi-Cal residual remains for some services and populations. | California forbids retroactive rescission of a prior authorization. Under Health & Safety Code 1371.8, once a plan authorizes a specific type of treatment and the provider renders it in good faith under that authorization, the plan cannot later rescind or modify the authorization 'for any reason' — including a later determination that the patient was ineligible. Verbatim: 'A health care service plan that authorizes a specific type of treatment by a provider shall not rescind or modify this authorization after the provider renders the health care service in good faith and pursuant to the authorization for any reason.' Most states allow eligibility-based retroactive takebacks; California does not, which makes an authorization number a far stronger collection asset here than elsewhere. | By the end of the sixth month following the month of service | View |
| Colorado | Health First Colorado runs no comprehensive risk-based MCOs — in CMS's 2024 managed-care enrollment file Colorado's only non-PACE managed care is the 'Accountable Care Collaborative (PCCM Entity),' delivered through seven Regional Accountable Entities (listed as RAE 1 Rocky Mountain Health Plans, RAE 2 Northeast Health Partners, RAE 3 and RAE 5 Colorado Access, RAE 4 Health Colorado Inc., RAE 6 and RAE 7 Colorado Community Health Alliance) plus Denver Health Medicaid Choice and Rocky Mountain Health Plans PRIME. | Colorado sets a hard 90-day outer deadline on every claim, not just clean ones — a pended, disputed or additional-information claim still has to be resolved within 90 calendar days of receipt. Verbatim, C.R.S. 10-16-106.5(4)(c): 'Absent fraud, all claims except those described in paragraph (a) of this subsection (4) shall be paid, denied, or settled within ninety calendar days after receipt by the carrier.' Colorado also requires carriers to run a receipt-confirmation mechanism for non-electronic claims and to list the claim on it within ten business days, with that listing date deemed the date of receipt — which gives a biller a documented start date for the prompt-pay clock on paper claims. | not yet read | View |
| Connecticut | HUSKY Health (Medicaid and CHIP) is run by the Department of Social Services through a single medical Administrative Services Organization rather than competing risk-bearing MCOs, so providers deal with one medical administrator statewide. Quotes: "HUSKY Health includes Medicaid and the Children's Health Insurance Program, and is administered by the Connecticut Department of Social Services (DSS)."; "the State of Connecticut's Medical Administrative Services Organization (ASO) for the HUSKY Health program". | HUSKY dental is carved out to a separate administrator, so dental claims do not route through the medical ASO. Quote: "The Connecticut Dental Health Partnership (CTDHP) is part of the HUSKY Health program. Specifically, the CTDHP provides management and customer service for the dental benefits portion of HUSKY Health." | not yet read | View |
| Delaware | Comprehensive risk-based managed care: KFF's 2024 table records 219,167 Delaware Medicaid enrollees in "comprehensive risk-based managed care" (about the whole program), so providers contract with plan networks rather than billing the state directly. The number and names of the contracted MCOs could not be sourced from a reachable official page. | Delaware limits a carrier to one additional-information request per claim, and starts a short second clock once you answer it: "A carrier may make only one request under this subsection in connection with a claim" and "A carrier who requests information under this subsection shall take action under sections 6.1.1 through 6.1.3 within 15 days of receiving properly requested information." (18 Del. Admin. Code 1310-6.2). Practical effect: a Delaware carrier cannot legitimately run a chain of serial documentation requests to stall a claim, and the payer owes an adjudication 15 days after your records go in. | not yet read | View |
| Florida | Near-universal managed care through Statewide Medicaid Managed Care (SMMC). SB 1950 (2022) realigned Florida's counties into nine regions rather than eleven, effective 2025, and AHCA implemented the new SMMC 3.0 program on February 1, 2025 under 2025–2030 plan contracts, so plan rosters and region numbers changed recently and older payer lists are stale. | Florida gives the biller a hard statutory kill-switch on payer stalling: under Fla. Stat. 627.6131, 'Failure to pay or deny a claim within 120 days after receipt of the claim creates an uncontestable obligation to pay the claim' for electronic claims, and the same language applies at 140 days for non-electronic claims. Very few states convert a payer's delay into an absolute, non-contestable payment obligation. The flip side is a tight filing window on the provider: claims 'must be mailed or electronically transferred to the primary insurer within 6 months' after inpatient discharge or the outpatient date of service, and to a secondary insurer 'within 90 days after final determination by the primary insurer.' | not yet read | View |
| Georgia | Managed care through Georgia Families, with only three contracted Care Management Organizations (CMOs) — Amerigroup Community Care, CareSource, and Peach State Health Plan — the smallest MCO panel of the five states reviewed. | Georgia carves its entire foster care, adoption assistance, and select juvenile justice population (~27,000 members) into Georgia Families 360°, a single statewide CMO run by Amerigroup Community Care of Georgia. If a practice sees foster children in Georgia, there is exactly one payer to contract with for that population regardless of county. | not yet read | View |
| Hawaii | Capitated managed care under the QUEST Integration 1115 demonstration — "QUEST Integration uses capitated managed care as a delivery system unless otherwise indicated" — with five health plans listed by Med-QUEST: AlohaCare, HMSA, Kaiser Permanente, Ohana Health Plan and UnitedHealthcare Community Plan. | Hawaii is the only state with an employer health-coverage mandate that survives ERISA preemption, so commercial coverage is near-universal among working patients and self-funded ERISA plans are far rarer than on the mainland. The state says: "Originally enacted in 1974, the Hawaii PHC Act was the first in the nation to set minimum standards of health care benefits for workers" and "Employers must provide health care coverage to employees who work at least twenty (20) hours per week and earn 86.67 times the current Hawaii minimum wage a month". Congress carved it out of ERISA at 29 U.S.C. 1144(b)(5): "subsection (a) shall not apply to the Hawaii Prepaid Health Care Act". | not yet read | View |
| Idaho | Still predominantly fee-for-service with narrow carve-outs — the state says it is "moving from the traditional fee-for-service system to a managed care model" but "The shift to a managed care model has been delayed to January 1, 2030"; today the only managed plans are the "Idaho Behavioral Health Plan" (Magellan), the "Idaho Smiles dental plan" (MCNA) and the dual-eligible "Medicare Medicaid Coordinated Plan (MMCP) and Idaho Medicaid Plus plans (IMPlus)" (Molina Healthcare of Idaho and UnitedHealthcare Community Plan of Idaho). | Idaho's prompt-pay protection is conditioned on the PROVIDER's own filing speed, which almost no other state does: the insurer's 30-day (electronic) / 45-day (paper) clock in Idaho Code 41-5602 only applies where the claim was submitted "within thirty (30) days of the date on which service was delivered" (electronic) or "within forty-five (45) days of the date on which service was delivered" (paper). File late and you lose the statutory deadline and the interest remedy entirely. | not yet read | View |
| Illinois | Mandatory managed care through HealthChoice Illinois: HFS contracts with five plans (four statewide plus one Cook County only) — Aetna Better Health of Illinois, Blue Cross Community Health Plan, Meridian Health Plan, Molina Healthcare, and CountyCare Health Plan (Cook County only). | Illinois Medicaid timely filing for non-institutional (professional) claims is only 180 days from date of service — roughly half the 365-day window most states allow — and it applies to resubmissions as well as originals. Medicare crossovers get 2 years, and TPL claims get 180 days after the primary payer's final adjudication. | 180 days from the date of service | View |
| Indiana | Indiana runs risk-based managed care for its main Medicaid populations alongside a Traditional Medicaid fee-for-service program administered by fiscal agent Gainwell Technologies; verbatim: "The Indiana Health Coverage Programs (IHCP) works with six health plans to serve as managed care organizations (MCOs) for the Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Indiana PathWays for Aging (PathWays) programs." Plans currently listed by program: HIP — Anthem, CareSource, MHS; Hoosier Healthwise — Anthem, CareSource, MHS; Hoosier Care Connect — Anthem, MHS, UnitedHealthcare; PathWays for Aging — Anthem, Humana, UnitedHealthcare. | Indiana Medicaid fee-for-service has a 180-day filing limit measured from the date of service (date of discharge for inpatient), not the 12 months most states allow. Verbatim from the official IHCP Claim Submission and Processing module (Section 11, published Feb. 24, 2026): "Providers must submit claims to the Indiana Health Coverage Programs (IHCP) within 180 calendar days of the date the service was rendered. For inpatient claims, the 180-day limit is based on the member's date of discharge. See the Indiana Administrative Code 405 IAC 1-1-3 for the complete rule narrative about filing limits." Crossover claims from Medicare and overpayment adjustments are exempt. | 180 days from the date of service | View |
| Iowa | Almost all Medicaid members are in the Iowa Health Link managed care program and choose one of three MCOs — Iowa Total Care, Molina Healthcare of Iowa, and Wellpoint Iowa — with dental benefits run through separate dental carriers (Delta Dental, DentaQuest) rather than the MCOs. | Iowa workers' compensation has no fixed medical fee schedule: disputed charges are referred to the workers' compensation commissioner, and a provider treating a compensable injury 'agrees to be bound by such charges as allowed by the workers' compensation commissioner and shall not recover in law or equity any amount in excess of charges set by the commissioner.' While a contested case is pending, no debt collection may be pursued against the injured employee, and the provider may send the employee only one itemized written bill. | 365 days from the date of service | View |
| Kansas | Statewide managed care under KanCare: nearly all Medicaid members are enrolled with one of three MCOs — Healthy Blue, Sunflower Health Plan, and UnitedHealthcare (contracts run Jan 1, 2025 through Dec 31, 2027). | Kansas is split between two independent Blue plans, so 'Blue Cross of Kansas' is not one payer. The BCBSKS service area 'Refers to the 103 Kansas counties -excluding Johnson and Wyandotte over which BCBSKS has jurisdiction relative to patient and provider contracts.' A practice in the Kansas City metro (Overland Park, Olathe, Kansas City KS) contracts, credentials and files with Blue KC, not BCBSKS — sending those claims to BCBSKS routes them to the wrong plan. | not yet read | View |
| Kentucky | Most Kentucky Medicaid members are in risk-based managed care; the Department for Medicaid Services contracts with five statewide MCOs, so a biller typically maintains five MCO contracts plus straight Medicaid. | Recoupment window is capped: an insurer may recover a claim overpayment only within 24 months of the date it paid the claim, and must first send notice identifying the overpayment, giving the provider 30 calendar days to dispute before recoupment proceeds (KRS 304.17A-714). Quote: "within twenty-four (24) months from the date that the insurer paid the claim". | 12 months from the date the service was rendered | View |
| Louisiana | Healthy Louisiana is full comprehensive risk-based managed care — CMS's 2024 file lists six 'Healthy Louisiana (Comprehensive MCO)' plans (Aetna Better Health of Louisiana, AmeriHealth Caritas Louisiana, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections, UnitedHealthcare Community Plan), plus separate statewide dental PAHPs (DentaQuest, MCNA). UnitedHealthcare's LDH contract was not renewed and expired Dec. 31, 2025 — verbatim from the MCO bulletin: 'The Louisiana Department of Health's (LDH) current contract with the Medicaid managed care organization (MCO) UnitedHealthcare will not be renewed and will expire on December 31, 2025' — leaving five MCOs from Jan. 1, 2026. | Louisiana's paper prompt-pay deadline slides based on how fast the provider bills — bill late and you hand the payer an extra 15 days. La. R.S. 22:1832(A)(1) gives contracted providers 45 days from receipt only where the claim was 'submitted by the provider or its agent within forty-five days of the date of service, or date of discharge'; 22:1832(A)(2) stretches that to 'not more than sixty days' for any claim 'submitted by the provider or its agent more than forty-five days after the date of service ... or resubmitted because the original claim was not an accepted claim or not a clean claim.' Every resubmission therefore drops onto the 60-day clock, not the 45-day one. Late payment carries a statutory 12% per annum adjustment (22:1832(C), 22:1833(D)), and the entire subpart expressly does not apply to the Office of Group Benefits, the state employee plan (22:1832(D), 22:1833(E)). | not yet read | View |
| Maine | MaineCare has no comprehensive risk-based Medicaid MCOs — KFF's 2024 managed care table reports Maine as "N/A" with the footnote "N/A: Not applicable. State had no contracts with comprehensive MCOs," so providers bill the state directly rather than a plan network. | When a commercial claim is denied because it did not conform to Maine's claim-form/undisputed-claim requirements, the provider is statutorily BARRED from balance-billing the patient and must fix and resubmit: "If a claim does not conform to the requirements specified in subsections 2-A and 2-C and payment is denied to a health care provider or health care facility by a carrier, the health care provider or health care facility may not request payment from the insured or beneficiary and shall attempt to rectify the deficiencies with the claim and resubmit the claim to the carrier." (24-A M.R.S. §2436(2-B)) | not yet read | View |
| Maryland | HealthChoice is Maryland's mandatory Medicaid managed care program — members pick an MCO and are auto-assigned if they do not ("If you do not choose an MCO, the State will automatically assign you to an MCO", https://health.maryland.gov/mmcp/healthchoice/pages/home.aspx). The CY2026 official performance report card lists nine participating MCOs: Aetna Better Health, CareFirst BlueCross BlueShield Community Health Plan, Jai Medical Systems, Kaiser Permanente, Maryland Physicians Care, MedStar Family Choice, Priority Partners, UnitedHealthcare and Wellpoint Maryland. | Maryland is an all-payer hospital rate-setting state: hospital prices are set by the Health Services Cost Review Commission, not negotiated payer by payer, so a Maryland hospital charges Medicare, Medicaid and every commercial plan the same rate for the same service. Statutory basis, verbatim from Md. Code, Health-General § 19-219: a hospital must "Charge for services only at a rate set in accordance with this subtitle" and "Comply with the applicable terms and conditions of the all–payer model contract", and "The rates are set equitably among all purchasers or classes of purchasers without undue discrimination or preference." Practical effect: contract-rate negotiation and payer-mix charge modelling on the hospital side are largely moot in Maryland; the leverage is in charge capture and HSCRC rate compliance instead. (Physician/professional claims are not rate-regulated.) | 12 months from the date of service | View |
| Massachusetts | MassHealth is ACO-led rather than MCO-led: state data (Sept 2025) show enrollment split across 15 Accountable Care Partnership Plans (ACPPs) and 2 Primary Care ACOs (Community Care Cooperative and Revere Health Choice), with only 2 MCOs remaining (WellSense and Tufts Health Public Plans), plus the PCC Plan and fee-for-service, and SCO / One Care / PACE for dual eligibles. | Massachusetts puts a hard clock on price quotes at the PROVIDER, not the payer: under M.G.L. c. 111, § 228, 'Prior to an admission, procedure or service and upon request by a patient or prospective patient, a health care provider shall, within 2 working days, disclose the allowed amount or charge of the admission, procedure or service.' A billing operation serving Massachusetts practices needs a 2-working-day estimate workflow that most states do not require. | 90 days from the date of service, or from another insurer's explanation of benefits | View |
| Michigan | Almost entirely comprehensive risk-based managed care — KFF counts 9 Medicaid MCOs in Michigan as of 2024, covering 2,362,189 enrollees, about 98% of the state's Medicaid population, leaving only a small fee-for-service remainder. | Michigan auto no-fault PIP is a distinct fee-scheduled payer no other state has. Since July 1, 2023, treatment of auto-accident injuries is permanently capped at 190% of the Medicare amount payable (it stepped down from 200% in 2021-22 and 195% in 2022-23), and payment may never exceed the provider's own average charge for that service on January 1, 2019. A Michigan practice must maintain a separate charge-history baseline and a Medicare-percentage pricing table just for auto claims. | not yet read | View |
| Minnesota | Medical Assistance is delivered mostly through capitated managed care; the DHS Managed Care Manual states verbatim: 'The State contracts with eight MCOs to provide medical services statewide for PMAP and PMCRE enrollees,' three of which are county-based purchasing entities (South Country Health Alliance, PrimeWest Health System, Itasca Medical Care); PMAP+, MSHO, MSC+ and SNBC all run through those plans. | Minnesota imposes a STATUTORY six-month timely-filing deadline that overrides nothing but binds everyone, and missing it kills the money entirely — you cannot bill the patient. Minn. Stat. 62Q.75 subd. 3(a): providers 'must submit their charges to a health plan company or third-party administrator within six months from the date of service or the date the health care provider knew or was informed of the correct name and address of the responsible health plan company or third-party administrator, whichever is later.' Subd. 3(b): a provider who misses it 'shall not be reimbursed for the charge and may not collect the charge from the recipient of the service or any other payer.' Subd. 3(g) extends the same rule to workers' compensation payers and no-fault reparation obligors. Offsetting protection in subd. 4: once a clean claim is paid, contracts must give a 12-month deadline on adjustments and recoupments. | not yet read | View |
| Mississippi | Managed care through MississippiCAN alongside a fee-for-service population: 'The Mississippi Division of Medicaid has contracts with three Coordinated Care Organizations' — Magnolia Health, Molina Healthcare, and TrueCare (UnitedHealthcare's contract ended in 2025). | Mississippi Medicaid applies hard countable service caps that most states do not: physician office visits are limited to '16 per fiscal year' on a state fiscal year running 'July 1 through June 30' (not the calendar year), and prescriptions are capped at '6 per month with no more than 2 of the 6 being brand name drugs.' Billers must track visit counts against a July–June year or claims deny once the cap is hit mid-treatment. | 365 calendar days from the date of service | View |
| Missouri | MO HealthNet splits members between managed care and fee-for-service by eligibility category; verbatim: "MO HealthNet offers healthcare coverage through either a Managed Care health plan (also referred to as MAGI) or the Fee-For-Service Program (referred to as non-MAGI)." Three general MCOs — "Healthy Blue, United Healthcare, or Home State Health" — cover parents/guardians, children, non-disabled adults 19-64 and pregnant women; seniors, people with disabilities and blind adults stay in fee-for-service; certain foster-care children go to the specialty Show Me Healthy Kids plan. | Missouri counts "processing days," not calendar days, and the clock stops while the carrier is waiting on the provider — verbatim: "'Processing days', number of days the health carrier or any of its agents, subsidiaries, contractors, subcontractors, or third-party contractors has the claim in its possession. Processing days shall not include days in which the health carrier is waiting for a response to a request for additional information from the claimant." The flip side is the harshest penalty in this group: "if the health carrier has not paid the claimant on or before the forty-fifth processing day from the date of receipt of the claim, the health carrier shall pay the claimant one percent interest per month and a penalty in an amount equal to one percent of the claim per day" — a per-DAY penalty where most states impose only monthly interest, which makes documenting the exact date each information request was answered the single highest-value habit for a Missouri A/R team. | 12 months from the date of service | View |
| Montana | No comprehensive risk-based Medicaid MCOs — KFF's 2024 table lists Montana as "N/A" with the note "N/A: Not applicable. State had no contracts with comprehensive MCOs"; Montana Healthcare Programs pays providers fee-for-service with a primary care case management (PCCM) overlay. | Montana's PCCM/medical-home programs are being replaced right now: a March 20, 2026 Montana Healthcare Programs provider notice states "Upon federal approval from the Centers for Medicare & Medicaid Services (CMS), Montana will implement the new Primary Care Montana (PCMT) program with an anticipated start date of July 1, 2026" and "When the new PCMT program begins, Montana's existing PCCM programs (Passport to Health, Comprehensive Primary Care Plus (CPC+), and Patient-Centered Medical Home (PCMH)) will end." Referral/attribution rules and PMPM case-management payments change accordingly. Separately, MCA 33-18-232(3) removes any private right of action for prompt-pay violations — the only remedy is a complaint to the insurance commissioner. | not yet read | View |
| Nebraska | Statewide managed care through Heritage Health with three MCOs — the state page reads "Heritage Health, Nebraska's Medicaid managed care program that combines the majority of Nebraska's Medicaid services into a single comprehensive system for Nebraska's Medicaid and CHIP members" and lists contracts for "Molina Healthcare", "Nebraska Total Care" and "UnitedHealthcare Community Plan". | Nebraska Medicaid runs an unusually short timely-filing window: 471 NAC 3-003 requires that "No more than 6 months have elapsed from the date of service when the claim is received by the Department", with a hard outer wall that "The Department will not pay claims received more than two years after the date of service, except under the circumstances specified in this chapter." Six months is half the 12-month filing limit most state Medicaid programs use. | not yet read | View |
| Nevada | Managed care, now statewide: five MCOs — Anthem Blue Cross and Blue Shield Healthcare Solutions, CareSource, Health Plan of Nevada, Molina Healthcare of Nevada, and SilverSummit Healthplan — with only a residual fee-for-service population. | On January 1, 2026 Nevada extended Medicaid managed care into the rural counties for the first time, moving roughly 75,000 rural residents out of fee-for-service. Rural members can only choose between two of the five plans: 'Rural Nevadans can pick from two managed care health plans starting January 1, 2026: CareSource and SilverSummit.' A rural Nevada practice that billed Nevada Medicaid FFS directly must now be contracted with those two MCOs. | not yet read | View |
| New Hampshire | Statewide mandatory managed care (Medicaid Care Management): "Medicaid Care Management (MCM), or managed care, delivers New Hampshire Medicaid health benefits and additional services through contracts between the Department of Health and Human Services (DHHS) and managed care organizations (MCOs)... In New Hampshire, there are three Medicaid Health Plans to choose from: AmeriHealth Caritas New Hampshire, NH Healthy Families, WellSense Health Plan." | Several service lines are carved OUT of the MCOs and must be billed fee-for-service to NH Medicaid/DHHS rather than to the member's health plan: "Some of your services will stay under New Hampshire Medicaid through the DHHS. These include children's dental care, nursing home, and home and community-based care (HCBC) services." A biller who routes a pediatric dental or HCBS claim to AmeriHealth/NH Healthy Families/WellSense will have it rejected. | not yet read | View |
| New Jersey | NJ FamilyCare moved off fee-for-service starting in 1995 and is now delivered through managed care: five MCOs participate statewide — Aetna Better Health of New Jersey, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan, and Wellpoint (formerly Amerigroup New Jersey). | Auto-accident care is a separate, state-controlled billing track: New Jersey is a no-fault PIP state, and under the N.J.A.C. 11:3-4 Medical Protocols Rule every provider treating a PIP patient must file Decision Point Review and precertification requests on the state's Uniform Attending Provider Plan Form, and bill against New Jersey's Automobile Medical Fee Schedule rather than any health-plan fee schedule. DOBI states: 'All providers treating PIP patients must use the Uniform Attending Provider Plan Form to submit Decision Point and Precertification Requests to Insurers.' | 1 year from the date of service | View |
| New Mexico | Near-universal managed care under Turquoise Care: "As of July 1, 2024, Turquoise Care members can choose from among four health plans, (also called Managed Care Organizations or MCOs)" — Blue Cross Blue Shield of New Mexico, Molina Healthcare, Presbyterian Health Plan and United Healthcare Community Plan; the same page adds "Children in state custody will be enrolled in the Presbyterian Health Plan" and "Native American members always have the choice between enrolling with a health plan or using Fee for Service health care providers." | New Mexico taxes health care services under its gross receipts tax, and Medicaid billing rules let the provider add that tax onto the claim itself — 8.302.2.10(H) NMAC states verbatim: "For providers subject and registered to pay, gross receipts tax, the provider may include gross receipt tax in the billed amount when the tax applies to the item or service." A biller working NM therefore has a tax component on the claim line that does not exist in most states. | 90 calendar days from the date of service | View |
| New York | Primarily managed care, in named product tiers: the NYS Medicaid Update refers to 'Mainstream Medicaid Managed Care, Health and Recovery Plans, and Special Needs Plans,' alongside Managed Long Term Care and Integrated Care for Dual Eligibles, with a residual fee-for-service segment billed through eMedNY. Enrollment reporting is published monthly by NYSDOH. | New York workers' compensation medical billing is now mandatorily electronic through a Board-approved XML partner, and the payer may lawfully deny for the wrong channel. The WC Board 'replaced 12 custom forms with the CMS-1500 and its use became mandatory in July 2022,' and 'As of August 1, 2025, the Board is requiring all health care providers in the workers' compensation system — regardless of office size or patient population — to submit the CMS-1500 universal medical billing form electronically through a Board-approved submission partner (also known as XML submission partner).' Critically: 'Starting August 1, 2025, the workers' compensation payer can deny payment of services if the CMS-1500 was not submitted through a Board-approved electronic submission partner and the Board will not enforce payment.' A CMS-1500 is also invalid without an attached detailed narrative report, and providers may bill CPT 99080 up to $1.00 per transaction to offset transmission cost. | 90 days from the date of service; finally payable within 2 years | View |
| North Carolina | Managed care through Prepaid Health Plans: four Standard Plans (AmeriHealth Caritas North Carolina, Healthy Blue of North Carolina, and UnitedHealthcare of North Carolina statewide, plus Carolina Complete Health in Regions 3, 4 and 5), a statewide Children and Families Specialty Plan (Healthy Blue Care Together), four Behavioral Health/IDD Tailored Plans (Alliance, Partners, Trillium, Vaya), and the EBCI Tribal Option. | North Carolina carves federally recognized tribal members and other IHS-eligible patients out of the Standard Plans into the EBCI Tribal Option — a Primary Care Case Management entity created and operated by the Cherokee Indian Hospital Authority, not a commercial payer. No other state Medicaid program has a tribally operated PCCM entity of this kind, and provider questions route to Provider.Services@cherokeehospital.org rather than a PHP provider line. | 365 days from the first date of service | View |
| North Dakota | Mostly fee-for-service through ND Medicaid, with exactly one MCO carve-out: the Medicaid Expansion population is administered by Blue Cross Blue Shield of North Dakota ("BCBSND administers coverage for North Dakota's Medicaid Expansion Program"), reported by KFF as 24,356 comprehensive MCO enrollees in 2024 — so a biller deals with two payers, not a panel of plans. | A provider taxonomy code is mandatory on every North Dakota Medicaid Expansion claim: "Providers submitting claims for North Dakota Medicaid Expansion members must include a taxonomy code, a 10-character code that designates the provider's classification and specialization." Same Medicaid program, but a different payer (BCBSND) and a different claim-content rule than traditional ND Medicaid. | not yet read | View |
| Ohio | Managed care through the Next Generation program with seven MCOs — AmeriHealth Caritas Ohio, Anthem Blue Cross and Blue Shield, Buckeye Community Health Plan, CareSource Ohio, Humana Healthy Horizons in Ohio, Molina Healthcare of Ohio, and UnitedHealthcare Community Plan of Ohio — plus the OhioRISE specialty plan for children with complex behavioral needs. | Ohio funnels all Medicaid EDI claims — fee-for-service and all seven MCOs — through one state-contracted EDI front door (vendor: Deloitte) rather than letting you submit to each plan, and every Medicaid pharmacy claim goes to a single statewide PBM (Gainwell Technologies), not to the member's MCO. You set up one trading-partner connection for the whole state, and pharmacy is carved out of the MCOs entirely. | 365 days from the date of service; from discharge for inpatient | View |
| Oklahoma | SoonerCare shifted most members into managed care on April 1, 2024 under SoonerSelect, with three statewide medical plans covering non-disabled children (including foster care), low-income parents, pregnant women and non-disabled adults 19-64. Quote: "Aetna Better Health of Oklahoma, Humana Healthy Horizons in Oklahoma and Oklahoma Complete Health." | Oklahoma's prompt-pay law carries a fee-shifting private remedy, which makes late-claim demand letters unusually effective: overdue payments accrue 10% simple interest per year and the prevailing party in litigation recovers attorney fees. Quote: "Pursuant to 36 O.S. § 1219(F), (G), an overdue payment shall bear simple interest at the rate of 10% per year. If litigation is brought, the prevailing party is entitled to recover a reasonable attorney fee." | 6 months from the date of service | View |
| Oregon | Oregon Health Plan members get care through regional coordinated care organizations (CCOs) rather than statewide MCOs; OHA's CCO contacts page lists 15 CCO/region entries as of 2026, and which one a provider bills depends on the patient's county. Quote: "Find websites, phone numbers and key contacts for Oregon's local coordinated care organizations (CCOs), including Health-Related Social Needs (HRSN) benefit information." | Virtual-card and EFT fees are restricted inside the prompt-pay statute itself: ORS 743B.450(3) lets an insurer pay by credit card or EFT only if it discloses the associated fees in advance, offers a fee-free alternative payment method, and the provider affirmatively elects the fee-bearing method. Quotes: "The insurer notifies the provider, in advance, of the fee or other charges associated with the use of the credit card or electronic funds transfer payment method"; "The insurer offers the provider an alternative payment method that does not impose fees or similar charges on the provider"; "The provider or a designee of the provider elects to accept a payment of the claim using the payment method". | not yet read | View |
| Pennsylvania | Mandatory managed care. Physical HealthChoices is Pennsylvania's mandatory Medicaid managed care program, organized into five zones — Lehigh/Capital, Northeast, Northwest, Southeast and Southwest — with roughly four to five physical-health MCOs offered per zone; the distinct plans listed on the DHS MCO page are AmeriHealth Caritas (Pennsylvania and Northeast), Geisinger Health Plan, Jefferson Health Plans EverWell, Highmark Wholecare, Keystone First, UPMC for You, and UnitedHealthcare Community Plan (seven brands statewide, but a given practice only faces the subset serving its zone). Community HealthChoices is the separate mandatory managed care program for dual eligibles, older adults and adults with physical disabilities. | Pennsylvania workers' compensation pays on a Medicare-derived cap, not a stand-alone state fee schedule: 34 Pa. Code 127.101 provides that 'Generally, medical fees for services rendered under the act shall be capped at 113% of the Medicare reimbursement rate applicable in this Commonwealth under the Medicare Program for comparable services rendered.' Two operational consequences a biller must know: 'Medicare coinsurance and deductibles may not be used to reduce the allowable fee under the act,' and the cap binds every licensed provider treating an injured worker 'regardless of whether the health care provider participates in the Medicare Program' — so a non-Medicare practice still gets priced off Medicare rates. An insurer may not pay above the cap unless paying under a contract with a Secretary-of-Health-certified CCO. | 180 days from the date of service | View |
| Rhode Island | Mandatory Medicaid managed care, delivered through RIte Care (parents/caretakers, pregnant women, children, foster children) and Rhody Health Partners (adults 19-64 without dependent children): "Participation in managed care is mandatory for the members of the MACC, non-MAGI and non-Medicaid funded coverage groups identified in § 2.1 of this Part except as specified in § 2.34 of this Part." The regulation does not state how many MCOs are under contract. | Late-paid clean claims accrue statutory interest automatically at 12% per year, with the clock keyed to claim media: "interest which shall accrue at the rate of twelve percent per annum commencing on the thirty-first day after receipt of a complete electronic claim or on the forty-first day after receipt of a complete written claim." A biller working RI A/R should be tracking day 31 (EDI) / day 41 (paper) and billing the interest, not just the principal. | not yet read | View |
| South Carolina | Healthy Connections Medicaid is predominantly comprehensive risk-based managed care; CMS's 2024 managed-care enrollment file lists five 'South Carolina Managed Care Organizations (Comprehensive MCO)' plans — Absolute Total Care Inc., First Choice by Select Health, Healthy Blue by Blue Choice, Humana Healthy Horizons and Molina Healthcare of South Carolina — plus one PCCM entity (SC Solutions) and three PACE organizations. | South Carolina gives a participating physician a statutory right to demand their own contracted fee schedule from the insurer — something most states leave entirely to contract. S.C. Code 38-59-220(A): 'each insurer, upon written request from a physician who is also a participating provider will provide, by CD-ROM, or electronically at the insurer's option, the fee schedule that is contracted with that physician for up to 100 CPT(r) Codes customarily and routinely used by the specialty type of such physician. Each physician may request from an insurer an updated fee schedule no more than two times annually.' The physician must keep it confidential or forfeit the right. Separately, 38-59-230(D) bans clearinghouses and billing services from converting a provider's electronic claims to paper before submitting them, and makes that an unfair trade practice — a direct constraint on how an RCM vendor may route SC claims. | not yet read | View |
| South Dakota | Pure fee-for-service: South Dakota contracts with zero comprehensive Medicaid MCOs (KFF 2024 MCO enrollment = N/A, defined as "N/A: Not applicable. State had no contracts with comprehensive MCOs."), so every claim goes to SD Medicaid itself; care coordination runs through state-run programs (PCP, Care Connect, BabyReady) rather than health plans. | Roughly 4 in 5 SD Medicaid recipients sit in a primary care case management program with a hard referral rule: the billing manual states "Approximately, 80 percent of South Dakota Medicaid recipients are required to enroll in the program," and "PCP Program covered services not referred by [the PCP]" are not covered — the referring PCP's provider number must appear on the claim or it denies. Urgent care gets only 4 referral-exempt clinic visits per state fiscal year (July 1-June 30), billed with EY REF*4N*1 electronically or in Block 19 on paper. | not yet read | View |
| Tennessee | TennCare is delivered almost entirely through at-risk managed care, not fee-for-service, with three MCOs (Wellpoint — formerly Amerigroup, BlueCare, and UnitedHealthcare Community Plan) plus the separate non-risk TennCare Select plan for defined populations; verbatim: "Medical, behavioral and long-term care services are covered by 'at risk' Managed Care Organizations (MCOs) in each region of the state, and each participating MCO creates their own contracts with providers, maintains their own fee schedules, processes their own claims" and "All 3 Managed Care Organizations for TennCare have passed the NCQA (National Committee for Quality Assurance) accreditation process." | Tennessee writes a timely-filing rule directly into its prompt-pay statute: a claim filed more than 90 days after the date of service is not a "clean claim" at all, so it loses every prompt-pay protection and interest right. Verbatim: "'Clean claim' does not include any claim submitted more than ninety (90) days after the date of service." Practical effect: a 90-day internal filing deadline on commercial TN claims, far tighter than the 12-month norm elsewhere. | 1 year from the date of service | View |
| Texas | Predominantly managed care: TMHP states 'The majority of Texas Medicaid benefits are delivered through Managed Care Organizations,' delivered through STAR (largest program), STAR+PLUS (21+ with disabilities or 65+, includes LTSS), STAR Kids (under 21 with disabilities), and STAR Health (foster care, administered statewide by Superior HealthPlan), plus dental maintenance organizations; a traditional fee-for-service (Traditional Medicaid) segment remains. | Texas attaches unusually punitive statutory damages to late clean-claim payment, calculated off billed charges rather than the contracted rate. Under Insurance Code 843.342, an HMO that pays 1–45 days late owes the contracted rate plus a penalty of the lesser of '50 percent of the difference between the billed charges ... and the contracted rate' or $100,000; 46–90 days late, the lesser of '100 percent of the difference between the billed charges ... and the contracted rate' or $200,000; and beyond 90 days, that penalty 'plus 18 percent annual interest on that amount.' This makes prompt-pay demand letters a genuine revenue line in Texas, unlike states that only add single-digit interest. Separately, a provider must enroll in Texas Medicaid through the PEMS portal before contracting and credentialing separately with each MCO. | 95 days from each date of service | View |
| Utah | Managed care is mandatory in the urban Wasatch Front counties and optional elsewhere: four plans (Health Choice Utah, Healthy U, Molina Healthcare, SelectHealth Community Care) operate alongside a state Fee for Service Network. Quote: "Members who live in any other county in Utah have the option of selecting a health plan or using the Fee for Service Network". | Utah statute mandates uniform claim submission across all health insurers, with the electronic standards set by the Insurance Commissioner through administrative rule rather than left to each payer. Quotes: "Except as provided in Subsection (1)(c), an insurer offering health insurance shall use a uniform claim form and uniform billing and claim codes." and "The uniform electronic standards and information required in Subsection (1) shall be adopted and approved by the commissioner in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act." | not yet read | View |
| Vermont | No commercial managed care: Vermont contracts with zero comprehensive Medicaid MCOs (KFF 2024 MCO enrollment = N/A; "N/A: Not applicable. State had no contracts with comprehensive MCOs."), and Medicaid is run directly by the Department of Vermont Health Access — the prompt-pay statute itself excludes "the Department of Vermont Health Access" from the definition of "payer". | Vermont puts a clock on the acknowledgement, not just the payment: "A health plan, contracting entity, or payer shall acknowledge receipt of an electronic claim to the submitting party within 24 hours after the beginning of the next business day following receipt of the claim." A Vermont payer that has not acknowledged an EDI claim inside one business day is already out of compliance — useful leverage on claims a payer says it never received. | not yet read | View |
| Virginia | Virginia Medicaid runs under one unified brand, Cardinal Care, with managed care (Cardinal Care Managed Care) delivered by five MCOs: Aetna Better Health of Virginia, HealthKeepers, Inc. (Anthem HealthKeepers Plus), Humana Healthy Horizons in Virginia, Sentara Community Plan, and UnitedHealthcare of the Mid-Atlantic, Inc. | Workers' compensation is billed off a mandatory, region-specific state fee schedule rather than 'prevailing community rate': Va. Code § 65.2-605 defines six 'medical communities' (Northern, Northwest, Central, Eastern, Near Southwest, Far Southwest, assigned by ZIP code) and provides that 'Separate initial Virginia fee schedules shall be established for fee scheduled medical services ... within each of the medical communities,' with 'The Commission's regulations that establish the initial Virginia fee schedules shall be effective on January 1, 2018.' The same CPT code pays differently depending on which of the six regions the service was rendered in. | not yet read | View |
| Washington | Washington Apple Health (Medicaid) is delivered mainly through Integrated Managed Care; HCA's 2026 Apple Health Managed Care Plan Comparison Guide lists five plans — Coordinated Care of Washington, Community Health Plan of Washington, Molina Healthcare of Washington, UnitedHealthcare Community Plan, and Wellpoint. | Washington is a monopolistic workers' compensation state: there is no private workers' comp carrier to bill. L&I states, 'Washington State does not allow private workers' compensation coverage. You must purchase your coverage from L&I or be a certified self-insured employer.' Every work-injury claim therefore goes to the Department of Labor & Industries State Fund or to a certified self-insured employer, on L&I's own rules and fee schedule — not to a commercial WC payer as in most states. | 365 calendar days from the date of service, with a TCN assigned | View |
| West Virginia | Mostly managed care under Mountain Health Trust with four MCOs — "Aetna Better Health of West Virginia", "The Health Plan of West Virginia", "Highmark Health Options of West Virginia" and "Wellpoint of West Virginia" — a program that "provides managed care services to approximately 87% of the state's Medicaid membership"; children on the Children with Serious Emotional Disorder Waiver "are automatically enrolled with Aetna Better Health of West Virginia" via Mountain Health Promise. | A large slice of West Virginia's commercial-type volume is PEIA (the state Public Employees Insurance Agency), a state agency that publishes its own fee schedules ("PEIA Fee Schedules and Manuals", including a "PEIA RBRVS") and has its own provider-add path administered by UMR rather than a carrier's normal credentialing: "New service providers in West Virginia should complete the Provider Demographic Worksheet and submit it with a copy of the W-9 form and the practitioner's license" (sent to westvirginiapeia@umr.com). | not yet read | View |
| Wisconsin | BadgerCare Plus is delivered mainly through HMOs with county-limited service areas, with fee-for-service as the fallback; verbatim: "Most people who get BadgerCare Plus get it through HMOs (health maintenance organizations). These are insurance companies that offer services from select providers. ... If you do not choose an HMO by the due date, we pick one for you." Thirteen HMOs are currently listed: Anthem Blue Cross and Blue Shield, Chorus Community Health Plans, Dean Health Plan, Group Health Cooperative of Eau Claire, Group Health Cooperative of South Central Wisconsin, Independent Care Health Plan (iCare), MercyCare Insurance Company, MHS Health Wisconsin, Molina Health Care, Network Health Plan, Quartz, Security Health Plan Wisconsin, and UnitedHealthcare of Wisconsin — only Anthem, MHS Health Wisconsin and UnitedHealthcare cover all counties, so the correct plan depends on the member's county. | Wisconsin has no workers' compensation medical fee schedule (outside pharmacy). Disputed WC fees are judged by the Department of Workforce Development against a certified fee database for the provider's geographic area, and the PROVIDER — not the insurer — carries a hard six-month deadline to open the dispute. Verbatim: "The provider must file with the department within six (6) months from the date they first received notice from the insurer, or self-insured employer, refusing to pay the provider's bill", and the insurer's answer must include "Information from a certified data base on fees charged by other providers for comparable services or procedures which clearly demonstrates that the fee in dispute is beyond the formula amount for the service or procedure within the provider's geographical area" (Wis. Stat. § 102.16(2); Wis. Admin. Code DWD 80.72). Practical effect: WC underpayments in Wisconsin are won or lost on a 6-month clock and on database comparables, not on a published fee schedule. | not yet read | View |
| Wyoming | Fee-for-service statewide with no comprehensive Medicaid MCOs (KFF 2024 MCO enrollment = N/A; "N/A: Not applicable. State had no contracts with comprehensive MCOs."); claims are processed by fiscal agent Acentra Health on behalf of the Wyoming Department of Health, Division of Healthcare Financing. | Wyoming Medicaid actively restricts out-of-state care, which matters because most Wyoming patients live near a border: "If services are available in Wyoming within a reasonable distance from the Member's home, the Member must not utilize an out-of-state Provider," and an out-of-state, non-enrolled provider "may choose to enroll in the Medicaid Program and submit the claim according to Medicaid billing instructions or bill the Member." Timely filing is a strict 12 months (365 days) from date of service; Medicare crossovers get 12 months from DOS or 180 days from the EOMB payment date, whichever is later. | not yet read | View |
Questions
Why does it matter whether a state is managed care or fee for service?
Because it decides how many payers you are actually dealing with. Under fee for service you bill the state. Under managed care you contract, credential and bill each plan separately, each with its own portal, its own filing window and its own appeal route. A practice that assumes one Medicaid and finds seven is, in our experience, the commonest reason a new state takes months longer to get paid in than expected.
Do I have to credential with every plan separately?
It depends on the state, and this is exactly where the quirk column earns its place. Ohio credentials centrally through its Provider Network Management module, so a provider is credentialed once at state level rather than once per plan. Illinois uses a single standardised roster template that every managed care plan must accept. Most states do neither, and each plan runs its own process.
How current is this?
Each row was gathered from the state agency or the plan itself and carries the link. Plan rosters change when a state re-procures its contracts, and several did recently, so treat the plan names as a starting point and confirm against the citation before you rely on a roster for a contracting decision.
Is this legal or enrollment advice?
No. It is a research summary to save you the first hour of looking. Enrollment rules are set by each state and each plan, and the only authority is the agency itself, which is why every row links to it.
Use it, no strings
No signup, no gate, no attribution required. If a row is out of date, tell us at ops@softhomeglobal.com and we will check the source and correct it.
See also: prompt pay deadlines by state, which covers how long a payer has to pay once the claim is clean.
If this is work somebody on your team is doing at four in the afternoon, it can be a seat.
Next step
Credentialing into a new state is somebody's whole week
A credentialing seat works enrollments, revalidations and the plan-by-plan paperwork so a lapse never quietly stops payment.
Or write to ops@softhomeglobal.com