H2026 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for H2026, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 7 of the 7 states list more than one rate for H2026, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 7 states, 2 publish H2026 per day, 1 per month, 1 per unit and 2 in other units, and 1 schedule prints no unit at all (a flat amount per service).
• Per hour. Time-based units are converted to an hour of service (four 15-minute units make an hour). 1 of the 7 states bill H2026 by time.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for H2026, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for H2026 run from $28.06 in Texas to $620.00 in Utah. The two publish it in different units (day versus hour), so part of that gap is the unit rather than the price. Half the states pay more than the median of $207.65 and half pay less. The usual reasons for a spread like this in other home & community services rates:

• Home and community-based services are often paid under waivers, and each waiver can set its own rate for the same service.
• Some services are paid per 15 minutes in one state and per day or per month in another.
• Case management may be paid as a monthly rate, a per-contact rate or in 15-minute units.

Timing matters too. 2 states set the current rate for H2026 in 2026 or later, while 1 state still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

What a plan pays for H2026 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 7 states.

In 1 state, plans negotiate and the published rate is a benchmark or out-of-network default. In 5 states, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 1 state is not classified yet.

• Paid by the state, outside the plans (5 states). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.
• Suggested schedule for plans (1 state). Use the schedule as a public benchmark in negotiations; the actual rate is whatever you and the plan agree.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Utah managed care.

H2026 is a HCPCS Level II behavioral health code in the other home & community services line, billed mostly by case management agencies, adult day centers, respite providers and other home and community-based services. H codes were created for state Medicaid agencies to bill mental health and substance use services. Each state defines the unit, which may be 15 minutes, an hour, a day or an episode.

Units range from 15 minutes to a day or a month, so a per-unit comparison only holds when the states use the same unit.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.