DOH Posts 2020 Personal Care and Consumer Directed Medicaid Rates  

Situation Report | September 8, 2020

The state Department of Health (DOH) recently issued the updated Personal Care and Consumer Directed Medicaid fee-for-service reimbursement rates.

The rates are effective January 1, 2020 through April 1, 2020 and April 2, 2020 through December 31, 2020, with the latter period including a reduction to Worker Recruitment and Retention (WR&R). That reduction was enacted in the state budget.

The rates are based on the lower of: 1) 2018 allowable costs (held to ceiling) projected to the 2020 rate period; or 2) your established charges as reported by your agency. For those programs that did not submit a 2018 certified cost report, DOH is not able to determine an initial 2020 rate until the certification(s) are submitted.

Further details can be found in Attachment A of the Dear Administrator Letter (DAL) available here. It provides additional details on: the administrative and general (A&G) cap; direct care and training costs and ceilings; profit and surplus percent; and miscellaneous adjustments for minimum wage.

DOH’s regulations allow rate appeals filed within 90 days of the DAL, dated August 19. The payment for the initial 2020 Medicaid rates will be made in cycle 2245, check release date of September 16, 2020.

Questions can be sent to and DOH’s Robert Yankowski will respond.