Three FQHC payment resets are now in motion. South Carolina's Department of Health and Human Services issued a Public Notice of Final Action amending its FQHC payment methodology effective April 1, 2026. North Carolina Medicaid's revised FQHC and RHC reimbursement methodology was approved in July 2025 and is already live. And on the federal side, the CY2026 Medicare FQHC PPS base rate rose to $207.72, a 2.5% increase over the CY2025 base of $202.65.
Every one of these changes re-opens the wrap reconciliation math between what MCOs pay and what the PPS floor guarantees. Health centers that do not re-model wrap receivables after a state amendment routinely understate AR.
Geo view
Where the resets are landing
The map below is the fastest way to see the moment we are in. Two neighboring Southeastern states have moved within nine months of each other, and the federal base rate that anchors Medicare FQHC payment moved with the calendar year. State regulators watching their own FQHC methodologies should read the Carolinas as the leading edge of a broader re-basing cycle, not as isolated events.
The mechanism
Why every methodology change re-opens the wrap math
The FQHC payment model has a floor. Managed care organizations pay their contracted rates on each encounter, and the state owes a supplemental wrap payment that brings total payment up to the PPS rate the center is entitled to. When a state amends its methodology, the floor itself moves, and every open reconciliation period is suddenly measured against a different number.
The wrap equation, visualized
Schematic, not to scale. The MCO portion is fixed by contract; the wrap portion is a derived residual. When the floor moves and the model does not, the residual is wrong on every encounter until the model catches up.
This is where AR quietly breaks. The wrap receivable is not a claim a payer adjudicates on its own; it is a calculation the health center must assert, support, and reconcile. If the finance team keeps accruing wrap against the pre-amendment methodology after an effective date like April 1, 2026, the accrual and the eventual settlement diverge. In our experience the divergence usually runs in one direction: the receivable is understated, because the model that generated it was never re-based.
Federal anchor
The Medicare base rate moved too
The Medicare side of the house is not exempt from this cycle. CMS set the CY2026 Medicare FQHC PPS base rate at $207.72, a 2.5% increase over the CY2025 base of $202.65. Centers billing Medicare FQHC PPS should confirm their expected-payment tables, contractual allowance logic, and variance reports all picked up the new base as of the CY2026 effective period.
Sequence
The reset timeline
Note the shape of that sequence. A state amendment approved mid-2025, a federal base reset at the calendar-year boundary, and a second state amendment landing mid-fiscal-year for many health centers. A center operating in or near the Carolinas now has three different effective dates slicing through its 2025 and 2026 encounter history, each one defining a different expected-payment regime for the encounters on either side of it. Reconciliation that ignores those cut lines is not reconciliation.
What regulators and health center CFOs should do now
The operator to-do list
- Pull the primary documents. Obtain the SCDHHS Public Notice of Final Action for the April 1, 2026 FQHC amendments and the approved NC Medicaid FQHC/RHC methodology from the state's own publications, and file them with your rate documentation.
- Re-base the wrap model at each effective date. Split your expected-payment logic at July 2025 for North Carolina, January 1, 2026 for the Medicare base, and April 1, 2026 for South Carolina, so every encounter is measured against the methodology in force on its date of service.
- Re-state open wrap receivables. Recalculate the accrued wrap for every unsettled reconciliation period that crosses an effective date, and book the adjustment rather than waiting for the state settlement to surprise you.
- Verify the $207.72 base propagated. Check Medicare FQHC expected-payment tables, contractual allowance percentages, and denial-variance thresholds against the CY2026 base, not the CY2025 figure of $202.65.
- Reconcile MCO payment files against the new floor. The MCO side of the equation did not change with the state amendment, which means the wrap residual did; confirm your MCO remittance data is complete before asserting the new wrap amounts.
- Brief the board with dated numbers. Present wrap AR by methodology period, not as one blended balance, so leadership can see exactly which regime each dollar belongs to.
Sources cited on this page: SCDHHS Public Notice of Final Action, FQHC payment methodology amendments effective April 1, 2026. NC Medicaid FQHC/RHC reimbursement methodology change, approved July 2025. CMS CY2026 Medicare FQHC PPS base rate of $207.72, a 2.5% increase over the CY2025 base of $202.65. All figures and dates are drawn from the named government publications; always confirm against the current official text before relying on them for rate setting or reconciliation.
Re-model the wrap before the state does it for you
ASP-RCM Solutions builds and runs FQHC revenue cycle operations that treat wrap reconciliation as a dated, methodology-aware calculation, not a blended guess. When a state amends its FQHC methodology, we re-base the expected-payment model at the effective date, re-state open wrap receivables, and give your board an AR picture that survives the settlement. If South Carolina's April 1, 2026 amendments or North Carolina's live methodology touch your health center, now is the time to check the math.
Talk to our FQHC team