Medicaid Fee‑For‑Service (FFS) Rates Effective July 1, 2026
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This memorandum publishes Hawaii Med-QUEST Division Medicaid FFS per-diem and PPS rates (including long-term care, hospice nursing facility, subacute, acute PPS and certain interim rates) effective for specified July 1, 2026 through dates shown; it is directed to QUEST Integration (QI) Health Plans and participating providers. The attachment lists provider-specific rates and effective periods.
No material clinical or coverage changes in this revision.
Rate Attachments and Effective Ranges
Attachments and effective ranges
Attachments list the provider-specific FFS rates and which rate tables apply for the indicated effective ranges.
ALL of the following
- Attachment list: Attachment A: FFS Waitlisted
- Attachment list: Attachment B: Long Term Care Rates (Acuity Based)
- Attachment list: Attachment C: Subacute Rate Summary
- Attachment list: Attachment D: Hospice Nursing Facility Rates
- Attachment list: Attachment E: Acute PPS Rates
- Attachment list: Attachment F: Critical Access Hospital Acute Interim Rates
- Attachment list: Attachment G: Critical Access Nursing Facility Interim Rates
ALL of the following
- Primary effective period for many attachments is July 1, 2026 through June 30, 2027.
- Some attachments (e.g. long-term care, hospice, subacute, waitlisted) show effective ranges that may end 12/31/2026 as indicated in attachments.
See attachments for provider-level effective date ranges and the specific rate table that applies to each provider.
Reimbursement rates and tables
Reimbursement stance and numeric rates are provided per provider and per rate type (routine per diem, ancillary per discharge, FFS & QI per diem, and NF per diem) for the effective periods shown.
ALL of the following
- Routine per diem examples: Routine per diem values shown (examples): 986.37; 1,032.31; 1,024.65; 1,160.17; 1,202.98 with component splits for SURG, MOTHER MATERNITY (0.735), NB (0.265), and MEDICAL as provided.
- Ancillary per discharge examples: Ancillary per discharge amounts shown (examples): 5,044.69 (with 0.735 MOTHER = 2,206.94; 0.265 NB = 875.42; MEDICAL = 2,231.08), 3,758.48, 4,435.93, 4,903.67, 7,279.06, 3,794.45, 5,507.62 as listed.
- FFS & QI Per Diem - Acute examples: FFS & QI Per Diem - Acute entries shown for Critical Access Hospitals (examples): Hale Ho'ola Hamakua = 4,349.89 for Maternity/NB/Except Maternity; Kahuku Medical Center = 2,973.54; Kula Hospital and others listed with their FFS & QI per diem values.
- FFS and QI NF Per Diem examples: FFS and QI NF Per Diem listed for named hospitals (examples): Hale Ho'ola Hamakua = 809.14; Kauai Veterans Memorial Hospital = 1,110.48; Kula Hospital = 645.95; Lanai Community Hospital = 1,256.87; Samuel Mahelona Memorial Hospital = 889.01.
Percent reference and per diem rule appear in hospice/nursing facility attachment.
Rate Types, Provider Classes, and Key Values
| CLASS 1-4 | Provider classification for Acute PPS rates (classes listed per provider) |
| ROUTINE PER DIEM | Routine per diem rates with breakdowns for SURG, MOTHER MATERNITY (0.735), NB (0.265), MEDICAL, and ALL SERVICES EXCEPT MATERNITY |
| ANCILLARY PER DISCHARGE | Ancillary per discharge amounts with maternity/NB/medical splits |
| FFS & QI Per Diem - Acute | FFS & QUEST Integration per diem acute rates (maternity, NB, except maternity) for Critical Access Hospitals |
| FFS and QI NF Per Diem | Nursing facility per diem interim rates for specific hospitals |
Notices, Contacts, and Billing Rules
Memorandum to QUEST Integration (QI) Health Plans; contact for questions
Med-QUEST issued a memorandum (Memo No. QI2614) to QUEST Integration (QI) Health Plans announcing the FFS rates effective July 1, 2026 and directing recipients to the attached provider rate tables; contact Ms. Maria Lui, Accountant, at (808) 900-6728 for questions.
Hospice nursing facility reimbursement — 95% of NF FFS rate
Hospice providers under contract with Medicaid nursing facilities are reimbursed at 95% of the current Nursing Facility Medicaid FFS rate, and nursing facility care is reimbursed on a per diem basis.
- Applies to Oahu and neighbor island hospice nursing facility care (Attachment D).
- Questions directed to Ms. Maria Lui at (808) 900-6728.
Providers excluded from APR-DRG (named providers and numbers)
The memorandum lists specific providers and provider numbers that are excluded from the APR-DRG Medicaid payment methodology for the period 7/1/2026–6/30/2027; each entry includes provider name, provider number, and assigned class.
- Examples include CASTLE MEDICAL CENTER (Provider Number 082268, Class 2), HILO MEDICAL CENTER (251745, Class 2), and KAISER HOSPITAL (082521, Class 1).
- A full list of excluded providers and their classes appears in the attachment for the effective period 7/1/2026–6/30/2027.
Terminology and Short Definitions
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