Updated Medicaid Hospital Inpatient Reimbursement Rates Effective October 1, 2024
2025/4/23
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Posted by Provider Relations
Fidelis Care would like to remind providers of the updated calculation of hospitals’ initial inpatient acute, exempt hospital, and exempt unit reimbursement rates for Medicaid Fee-for-Service (FFS) and Medicaid Managed Care (MMC), which were effective October 1, 2024.
As per Medicaid DOH site, an administrative letter was published to support reduction to the capital rate add-ons. Providers should have received notification from the State regarding this rate update.
The October 1, 2024 Medicaid FFS rates have been approved by the New York State Division of the Budget (Budget) and have been transmitted to eMedNY for payment and retroactive claims processing.
These rates are based upon the same information and methodology as the inpatient rates effective January 1, 2024 and April 1, 2024, but take into consideration the following updates effective October 1, 2024:
- Increase in the reduction percentage to all 2024 hospital inpatient budgeted capital rate add-ons from 10% to 20%, per the State Fiscal Year (SFY) 2024-25 Enacted Budget
- Increase in reduction percentage to all 2020 hospital inpatient reconciled capital rate add-ons from 10% to 20%, per the SFY 2024-25 Enacted Budget
The updated rates were made available to Fidelis Care on January 9, 2025, and were active in our system as of April 3, 2025. Adjustments to claims with discharges on or after October 1, 2024 are being processed accordingly.
Should you have any questions regarding the updated rates, please send an email to the hospital rate-setting unit at HospFFSunit@health.ny.gov.
For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.