Senate Bill No. 499 requires the Commissioner of Social Services to implement phased increases to Medicaid provider rates starting July 1, 2026, and continuing through June 30, 2029. The increases will be based on a Medicaid rate study, aiming to align rates to at least 75% of the most recent Medicare rates for similar healthcare services. For services lacking corresponding Medicare rates, the bill specifies that rates will be determined based on a percentage of a five-state rate benchmark, which includes Maine, Massachusetts, New Jersey, New York, and Oregon. After June 30, 2029, the commissioner must adjust these rates annually according to the same criteria. The bill also mandates the consolidation of existing fee schedules to ensure uniform reimbursement across providers, incorporating the latest Medicare fee schedule where applicable.

Additionally, the bill establishes the Council on Medical Assistance Program Oversight (MAPOC) to conduct ongoing reviews of Medicaid provider reimbursement rates, ensuring they are sufficient to maintain a robust provider network for Medicaid enrollees. MAPOC is tasked with submitting annual reports to the General Assembly's Appropriations and Human Services committees, starting January 15, 2027, with recommendations for necessary appropriations to meet updated compensation standards for Medicaid providers. The bill builds on the requirements set forth in PA 23-186, which called for a comprehensive study of Medicaid rates across various provider categories, and includes provisions for reviewing rates studied under this mandate, particularly focusing on those without corresponding Medicare or five-state benchmark rates. The bill is set to take effect on July 1, 2026.