The 50-state FQHC Medicaid rate calendar and reprocessing rulebook.
When does your Medicaid PPS rate reset, what drives the change, what does a change in scope have to clear, who owes the wrap, and how long does a plan have to reprocess paid claims after a retroactive rate change. Fifty states plus the District of Columbia, every populated cell linked to the state document it came from, every gap marked as a gap.
jurisdictions
Four questions this answers before your rate moves.
1. Find your reset month and put it on the calendar. Filter the table by reset month. If your state resets October 1 and your billing system still holds the old encounter rate on October 2, every claim that goes out is short and every one of them will need a retroactive correction later.
2. Read what drives the change. Most states trend by the Medicare Economic Index. Some use a market basket, some use a state index, and some do both on different lines of service. The driver decides whether the number you are forecasting is a federal publication or a state memo.
3. Check the change-in-scope threshold and deadline before you add a service line. A threshold you miss by a tenth of a percent produces no rate change at all, and a filing deadline you miss produces no rate change either, no matter how large the cost shift was.
4. Know who owes the wrap and how long a plan has to reprocess. A retroactive rate change is only money once someone reprocesses the paid claims. The last column is the clock that governs that, where the state published one. Pennsylvania, below, is the clearest published example in the country.
This calendar sits next to the FQHC payer matrix, which tracks how each payer class is expected to pay you, and the wider payer policy matrices. For the operating side of the same problem, see FQHC billing services.
Pennsylvania runs three clocks and a fourth one nobody counts.
Pennsylvania is the state that writes the retroactive-rate machinery down in full, across two documents: the FQHC/RHC handbook that binds the centers, and the HealthChoices agreement that binds the plans. Read together they say exactly when the money has to move and what happens when it does not.
The Department notifies quarterly
Retroactive PPS rate changes are batched. The Department tells the plans once a quarter about the changes it completed in that quarter, and that notification date starts everything else.
The plan has 90 days to reprocess
From the notification date, the MCO has ninety days to reprocess every paid encounter back to the effective date of the retroactive change. The obligation to pay the center, or to recover an overpayment from it, stays with the plan.
10 business days to confirm, or $30,000
The plan must notify the Department that it finished, within 10 business days of completing the reprocessing. Failure triggers the full 90 day claims processing sanction of $30,000, and the Department completes the settlement in place of the plan and recovers that amount from a future payment.
The wraparound report
Unrelated to the reprocessing clocks: the quarterly MCO settlement report, the Wraparound Report, is due seven months after the end of each calendar quarter, and the Department will not accept a report or a revision more than two years past that due date.
Verbatim, from the FQHC/RHC handbook:
“The Department notifies the MA MCOs of retroactive PPS rate changes that have been completed each quarter. The MA MCOs have ninety (90) days from the date of the Department’s notification to complete claims reprocessing for any paid encounter with a date of service back to and including the effective date of the PPS retroactive rate change. The obligation for payment to the FQHC/RHC, or to collect overpayments from the FQHC/RHC, is maintained by the MA MCO.”
“FQHCs and RHCs are required to submit the quarterly MCO settlement report seven (7) months after the end of each calendar year quarter. This quarterly report is sometimes referred to as the Wraparound Report.”
“The Department will not accept a Wraparound Report or revision to a prior period Wraparound Report for quarters that are more than two years beyond the required submission date. The Department limits to the two-year timely filing per 45 CFR 95.7.”
Verbatim, from the HealthChoices Physical Health Agreement, Section VII.E.5.f:
“The PH-MCOs will have 90 Days from the date of the Department’s notification to the PH-MCO of a retroactive PPS rate adjustment to reprocess all applicable FQHC and/or RHC Claims that were subject to the requirements of Section VII.E.5.a above. The PH-MCO must send notification to the Department that it reprocessed the Claims as required within 10 Business Days of the completion of the required Claims reprocessing.”
“Failure to complete the required Claims reprocessing for each FQHC and RHC and to submit notification of the completion of the Claims reprocessing to the Department will result in the full assessment of the 90 Day Claims processing sanctions in Section VII.D.2 totaling $30,000. In addition to the sanction amount, the Department will complete a settlement in place of the PH-MCO’s Claims reprocessing for the FQHC or RHC. The amount the Department pays to the FQHC or RHC for this settlement will be an obligation of the PH-MCO to the Department and recovered by the Department from the PH-MCO through a reduction to a future payment.”
Sources: PROMISe Provider Handbook, Appendix E, FQHC/RHC Handbook (revised November 1, 2024) · Medical Assistance Bulletin 99-26-01, carrying the handbook edition revised January 1, 2026 · HealthChoices Physical Health Agreement effective January 1, 2026, Section VII.E.5.f · Pennsylvania State Plan Attachment 4.19-B
110 of 250 data points are not published anywhere.
50 states, five rules each
We checked five rules in each of the fifty states: when the rate resets, whether there is a scheduled rebase, the change-in-scope threshold and deadline, the wraparound method and who pays it, and the retroactive reprocessing rule. That is 250 data points. 140 of them are published and linked here. 110 of them are not published by the state at all, and those cells say Not published rather than showing a plausible guess. Pennsylvania is carried separately, in full, as the worked example above, which brings the table to 51 jurisdictions and 145 sourced cells.
Not published is a finding, not a failure to look. Each blank cell names the documents that were checked. Where a state publishes a rule that has no calendar date, the reset month reads Varies and the cell explains what the date depends on.
Rates themselves are provider-specific in most states and arrive by letter. This calendar is the rules layer, not a rate table. In many states each center has its own encounter rate, built from its own cost report, and the state sends it to that center directly in a rate letter or a portal notice. Several states publish no rate table at all. If your rate letter and this calendar disagree, your letter governs.
Managed care contracts can also add duties the state plan does not carry. Pennsylvania is the clearest case: the 10 business day notice and the $30,000 sanction live only in the plan agreement, not in the provider handbook. Read both for your state before you argue a reprocessing timeline with a plan.
51 jurisdictions, five rules, every cell sourced.
Sort any column. Filter by reset month. Search a state, a threshold, a deadline or a document name.
Compiled from state primary sources and verified on September 18, 2026. Rules change. Confirm against your own rate letter and your plan agreements before you act on a number.
If the calendar says your rate moved, somebody has to go get the money.
A retroactive rate change is a reprocessing project, an encounter data project and a wraparound reconciliation project at once. See what FQHC billing services covers, check payer-by-payer expectations in the FQHC payer matrix and the full set of payer policy matrices, read how we price the work, or tell us which state you are in.
Related reading: The rate resets October 1: who owns the 90-day reprocessing window.