Agree
- Both the state and the center agree; states should be able to prove it [9]
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FQHC Medicaid APM tracker 2026: the state plan amendments, dated and linked
Short answer: 2026 brought two new or expanded APM approvals (South Dakota, Tennessee), three other FQHC payment approvals (DC, California, Arizona) and one submission awaiting CMS (Nevada).
1902(bb)(6) · APM floor = PPSSD 26-0001 · Aug 13, 2026TN 25-0001 · Feb 25, 2026Verified Oct 25, 2026
Edition
Oct 2026
Focus
Medicaid APM
States
SD · TN · DC · CA · AZ
Framework
1902(bb)(6)
Metric
APM floor = PPS
Length
5 min read
2026 FQHC payment state plan activity, verified October 25, 2026
| State and SPA | Approved | Effective | What it does | Floor and rate language | Source |
|---|---|---|---|---|---|
| South Dakota 26-0001 | Aug 13, 2026 | Jul 1, 2026 | Medical and dental APM elections; MEI update from July 1, 2027; re-evaluation at least every 5 years; change-in-scope 5% threshold | APM rates at least equal to PPS; medical $336.71, dental $390.36; written election | [1] |
| Tennessee 25-0001 | Feb 25, 2026 | Jun 4, 2025 | Option 1: rebased rate from the two most recent fiscal years, updated at most every 5 years; Option 2: separate dental rate | State pays the difference if PPS exceeds the APM; no recoupment the other way | [2] |
| District of Columbia 26-0002 | Jun 23, 2026 | Jan 1, 2026 | Reschedules the next FQHC rate rebasing from January 1, 2026 to January 1, 2027 | No rate stated | [3] |
| California 26-0001 | May 15, 2026 | May 1, 2026 | Dental codes aligned to CDT 2026; dental supplemental payment codes, 20 to 60 percent of the schedule of maximum allowances | Fee schedule and supplement, not an encounter rate | [4] |
| Arizona 26-0002 | Sep 24, 2026 | Jan 1, 2026 | FQHC and RHC coverage limits on dentistry, podiatry, optometry and chiropractic | Benefit page, no rate | [5] |
| Nevada 26-0005 | Not posted at check | Feb 22, 2026 (as submitted) | Managed care requirements, out-of-state FQHC rate method; multi-visit service-specific APM up to three encounters per day | APM must pay at least the PPS entitlement; MEI each October 1 | [6] |
Approval dates, in order
- 1Feb 25, 2026Tennessee 25-0001 approved [2]
- 2May 15, 2026California 26-0001 approved [4]
- 3Jun 23, 2026DC 26-0002 approved [3]
- 4Aug 13, 2026South Dakota 26-0001 approved [1]
- 5Sep 24, 2026Arizona 26-0002 approved [5]
- 6Sep 25, 2026Maine FY27 rate letters posted [7]
New or expanded APM
Tennessee, South Dakota
Payment or benefit change
California, DC, Arizona
Awaiting approval
Nevada 26-0005, submitted Mar 25, 2026 [6]
APM electionsOther FQHC payment approvalsSubmitted, not yet posted
Both rates in one 2026 document: South Dakota
State bulletins that change the math without a new SPA
| State | Design | Trend | Rebase | Source |
|---|---|---|---|---|
| Maine | APM rates above PPS, confirmed by annual review | Per FY rate letters | Annual letters | [7] |
| North Carolina | 113% of 2021 allowable cost | Greater of FQHC market basket or medical CPI | Triennial | [8] |
| Nevada | Multi-visit service-specific APM: medical, behavioral health, dental | MEI each October 1 | On change in scope | [6] |
Section 1902(bb)(6), and what each state adds
At least PPS
- Payment at least the full PPS rate [9]
Change in scope
SD
- Six months in place, notice within nine, one adjustment a year; new rate 30 days after receipt [1]
Cost report clock
TN
- 120 days from a cost report submission to initiate a change in scope [2]
Takeaway
An election form is a contract. Read the trend index, rebase interval, change-in-scope rights and exit terms before signing, and run the floor test by service line.
If your state is on the list, four checks
Run the floor test by service lineYour own encounter file against PPS by site; method in the FQHC APM versus PPS decision guide.
Calendar the reset datesFQHC rate calendar.
Prove the floor monthlyVariance against PPS, in the FQHC KPI scorecard.
Check payer-level rulesFQHC payer matrix; FQHC billing services run the variance file.
Frequently asked questions
Which states approved an FQHC APM state plan amendment in 2026?
From the CMS approval letters we opened: South Dakota SPA 26-0001 (medical and dental APM from July 1, 2026, approved August 13, 2026) and Tennessee SPA 25-0001 (APM options effective June 4, 2025, approved February 25, 2026). The District of Columbia, California and Arizona approvals in 2026 touch FQHC payment or benefits without creating a new APM. Nevada's 26-0005 was submitted in March 2026 and its approval was not posted on medicaid.gov when we checked.
What dental encounter rates appear in the 2026 SPAs?
South Dakota's approved dental APM encounter rate is $390.36 from July 1, 2026, against a medical APM rate of $336.71. Tennessee's Option 2 lets an FQHC request a separate dental rate built from its two most recent fiscal years of dental cost, with an interim statewide average until then. California's 26-0001 updates dental codes and supplemental payments rather than setting an encounter rate.
What is the APM floor language?
Every approved page restates the statutory test from section 1902(bb)(6): the center agrees to the APM, and payment is at least the PPS amount. South Dakota says APM encounter rates will be at least equal to the FQHC's PPS rate. Tennessee adds that if PPS exceeds the APM payment the state reimburses the difference and no recoupment is made the other way.
How often is this tracker updated?
Monthly. We re-check the CMS SPA postings and state Medicaid bulletins and add rows with the approval date, effective date and a link. Anything we could not open at its source is left out rather than guessed.
- CMS approval, South Dakota SPA 26-0001, RHC and FQHC payment methodology, medical and dental APM (approved August 13, 2026, effective July 1, 2026)
- CMS approval, Tennessee SPA 25-0001, FQHC APM options (approved February 25, 2026)
- CMS approval, District of Columbia SPA 26-0002, FQHC rate rebasing rescheduled (approved June 23, 2026, effective January 1, 2026)
- CMS approval, California SPA 26-0001, CDT 2026 dental codes and dental supplemental payments (approved May 15, 2026, effective May 1, 2026)
- CMS approval, Arizona SPA 26-0002, FQHC and RHC service limitations (approved September 24, 2026, effective January 1, 2026)
- Nevada Health Authority, SPA 26-0005 transmittal to CMS, RHC and FQHC rate methodology (March 25, 2026, effective February 22, 2026)
- MaineCare provider bulletin: Section 31 FQHC Fiscal Year 2027 rate letters (September 25, 2026)
- NC Medicaid bulletin: Updated FQHC and RHC Reimbursement Methodology, SPA 23-0021 and 23-0022 (July 3, 2025)
- CMS State Health Official letter SHO #16-006 on FQHC and RHC APMs and supplemental payments (April 26, 2016)
Checked October 25, 2026. Rules change, and proposed rules are not final until CMS publishes them; confirm against the source before relying on them.
Is your state on this list?
We model the APM against your PPS rate by site and service line from your own encounter file, and give the board a variance table with the state document attached.