Minnesota Medicaid managed care: what plans must pay
Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Minnesota's plan contracts, statutes and notices. For 12 of 21 service lines, plans must follow a rule tied to the state's published rates.
- Lines with a binding rule
- 12of 21
- Plans on record
- 9
- Directed payments
- 8
- Capitation cells
- 1,186$14.82–$7,421.87 PMPM
Who sets the rate, by service line
| Service line | Main rule for plans | Rates | Also applies |
|---|---|---|---|
| Physician & professional | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 20,478 | Plans must pay at least thisPlans must pass increases through |
| Hospital outpatient | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 9,424 | Plans must pay at least this |
| Other home & community services | Paid by the state, outside plansPaid directly by the state, outside managed care | 7,702 | Plans must pay at least thisPlans may pay no more |
| Equipment & supplies | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 3,056 | Paid by the state, outside plansPlans must pay at least this |
| Radiology | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 2,497 | |
| Hospital inpatient | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 2,231 | |
| Lab & pathology | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1,655 | |
| Other | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1,242 | State-directed payment |
| Pharmacy | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 930 | |
| Behavioral health | Plans must pass increases throughPlans must pass through state rate increases | 543 | Plans must pay at least thisPlans negotiate; applies out of network |
| Dental | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 240 | Plans must pay at least this |
| IDD services | Paid by the state, outside plansPaid directly by the state, outside managed care | 228 | Plans negotiate; applies out of networkPlans must pass increases through |
| Personal care & attendant | Paid by the state, outside plansPaid directly by the state, outside managed care | 216 | Plans must pay at least thisPlans negotiate; applies out of network |
| Therapy (PT/OT/speech) | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 66 | Plans must pay at least thisPaid by the state, outside plans |
| Transportation | Plans must pay at least thisPlans must pay at least the published rate | 46 | Plans negotiate; applies out of networkPaid by the state, outside plans |
| Private duty nursing | Paid by the state, outside plansPaid directly by the state, outside managed care | 42 | Plans must pay at least thisPlans negotiate; applies out of network |
| Home health | Paid by the state, outside plansPaid directly by the state, outside managed care | 38 | Plans must pay at least thisPlans negotiate; applies out of network |
| Vision & hearing | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 32 | |
| ABA / autism services | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 7 | |
| Nursing facility | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1 | |
| Clinics (FQHC/RHC) | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1 |
State-directed payments
Payments CMS approved under 42 CFR 438.6(c) that plans must make on top of, or as a minimum for, their negotiated rates.
| Program | Amount | Effective |
|---|---|---|
| Minnesota managed care state directed payments (42 CFR 438.6(c)) | $4.50 | 2026-01-01 |
| Minnesota managed care state directed payments (42 CFR 438.6(c)) | 1% | 2026-01-01 |
| Minnesota managed care state directed payments (42 CFR 438.6(c)) | 3% | 2026-01-01 |
| Minnesota managed care state directed payments (42 CFR 438.6(c)) | 5% | 2026-01-01 |
| Minnesota managed care state directed payments (42 CFR 438.6(c)) | 3% | 2026-01-01 |
| Minnesota managed care state directed payments (42 CFR 438.6(c)) | $3.65 | 2026-01-01 |
| Minnesota managed care state directed payments (42 CFR 438.6(c)) | $4.50 | 2026-01-01 |
| Minnesota managed care state directed payments (42 CFR 438.6(c)) | $8.15 | 2026-01-01 |
Frequently asked questions
Do Minnesota Medicaid plans have to pay the state fee schedule?
For some services. Plans must follow a rule tied to the state's rates for: Physician & professional, Hospital outpatient, Other home & community services, Equipment & supplies, Behavioral health, Dental, IDD services, Personal care & attendant, Therapy (PT/OT/speech), Transportation, Private duty nursing, Home health. For other lines, plans negotiate rates with providers.
Where do these rules come from?
From Minnesota's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.
Can I see what each plan actually pays?
No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.
← All Minnesota Medicaid rates