DOH Monthly Briefing – January 2026
DOH held its Monthly Briefing earlier today. The following summarizes the topics discussed:
1/1/2026 Notice Rates
The corrected 1/1/26 notice rates were posted on the Health Commerce System (HCS) application (Healthcare Financial Data Gateway) under the heading of “2026 Notice Rates” on November 3, 2025.
The all-inclusive rates provided on the Gateway include the following components:
- Operating Component: The non-specialty rates reflect the pricing methodology as prescribed by Title 10, Part 86-2.40 of the Commissioner’s Administrative Rules and Regulations. The 2026 minimum wage adjustments will be added prospectively.
- Capital Component: The capital component of the 2026 notice rates is based upon the facility’s 2024 certified cost report, as well as the latest approved financing arrangements. The 5% and additional 10% reductions implemented with the State Fiscal Year 2021-22 and 2024-25 Enacted Budgets are now incorporated into the capital schedule at the bottom labeled “Total (95%) and Total (Additional 10% Reduction), respectively.”
- DOH continues to process specific capital attestations, and once completed, will revise the 2026 rates sometime later in Q1 2026.
Federal Share of $285M Rate Increase
The federal share of one-time investments was recently approved by CMS. The state share of the additional $285M increase to nursing homes enacted in the FY 2024-25 Budget was processed in Medicaid cycle #2458 (check release date 10/16/24). The federal share of the $285M was paid in Medicaid cycle #2517 (check release date 12/3/25). Each nursing home received a lump sum adjustment of $13.53 per day multiplied by their 2022 billed Medicaid days.
The SFY 2025-26 approved budget funding of $485M is contingent on approval of the MCO tax (see below).
MCO Tax
In the FY 2025-26 enacted State Budget, New York allocated $440M in SFY 2025-26 and $385M in SFY 2026-27 from its MCO tax for nursing homes; and $15M in SFY 2025-26 and $15M in SFY 2026-27 from its MCO tax for assisted living program providers. On November 14, 2025, CMS issued a guidance letter that included timelines for closing certain MCO provider tax loophole provisions.
CMS’ letter is promising in that (1) the language of the preliminary guidance letter seems to keep the SFY 2025-26 MCO tax funding intact; and (2) CMS’s letter further states that the 2026 date “is the minimum transition period that may be available,” and that additional time may be provided to states (up to the 3 fiscal year maximum allowed under OBBBA) depending on the language that is ultimately included in CMS’ final rule. DOH stated that they do not have a date for a lump sum payout as they continue to wait for federal regulations to be promulgated prior to enacting any State Budget actions which are tied to it.
Case Mix Freeze
The final enacted State Budget froze the case mix date effective July 1, 2023 until full implementation of the PDPM case mix methodology is developed. The SPA was approved by CMS, effective April 1, 2024. NYSHFA successfully obtained a stipulation of settlement with DOH and the Attorney General’s office to recalculate and pay the Medicaid rates from 1/1/24-3/31/24 with a case mix adjustment based on the MDS submissions for the period from 4/1/23-9/30/23 as required by law in effect at the time.
Per the legal stipulation, DOH has referred certain petitioners to OMIG and the Attorney General’s office for subsequent review prior to payment. For all other non-referred petitioners, DOH processed the January 2024 case mix update in Medicaid cycle # 2521 (check release date 12/31/25). NYSHFA’s general counsel has just received a list of the facilities on the so-called “Referred” List and will be notifying each facility individually.
PDPM
Myers and Stauffer (M&S) are now analyzing the quarterly MDS data set from July – September 2025. DOH reported positive results in analyzing this data and can now review all scoring and weighting options for the PDPM transition. M&S will begin submitting modeling options to DOH in an effort to best reflect resident acuity in the rates. DOH indicated possible Q2 2026 for next steps and will reconvene with NYSHFA as soon as the revised data model becomes available.
Advanced Training Initiative (ATI)
DOH provided information on the 2025-26 ATI program on 11/26/25. The application survey to facilities with direct-care staff retention rates above the statewide median will be eligible to apply for the estimated $3.47 per diem add-on (dependent upon an approved training
program.) Survey applications were extended to 1/7/26, and the approval of the ATI program is currently in executive review. NYSHFA will continue to offer a variety of ATI training programs for members and non-members.
2% Supplemental
The 2% supplemental rate package is currently under executive review and should be processed by the end of Q1 2026.
2024 NHQI
Quality scores were released to DOH rate-setting, and the subsequent rate package is being planned in Q2 2026.
2024 Cash Receipts Reconciliation (CRA)
The 2024 CRA reconciliation will be processed upon completion of the 2024 NHQI rate package.
NYSHFA | NYSCAL CONTACTS:
Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x.11
Carl J. Pucci
Financial Consultant
518-462-4800
