A Medicaid Patient No-Showed: Your State Medicaid Rule Decides the Fee

Can you charge a Medicaid patient a no-show fee?

Usually not, and the rule that decides it is your state's. Federal law makes accepting the Medicaid payment as payment in full a condition of participating at all 1Ref 1Centers for Medicare & Medicaid Services, HHS (2023).Acceptance of State payment as payment in full.The federal payment-in-full condition on Medicaid participation: a state plan must limit participation to providers who accept the agency's payment plus any plan-required deductible, coinsurance or copayment as payment in full, and the fact that the section itself does not name missed appointments.. Texas, Ohio and Washington each bar the charge outright, and two of them point back at federal policy, Ohio at that very section. Your own state's Medicaid rule is the one that binds you, and it is findable in an afternoon.

The answer varies by state because the operative document is a state document. Federal regulation sets the condition of participation, then hands each state the job of writing the agreement and the manual that spell it out 2Ref 2Centers for Medicare & Medicaid Services, HHS (2023).Required provider agreement.The structural point that the binding instrument is a written agreement between the state Medicaid agency and each participating provider, which is why the operative missed-appointment rule sits in a state document.. Neither federal section says the words missed appointment.

So the first move is to open your own state's provider manual to the section on billing the client. That is where each of the three rules below sits, and where yours will be if you have one.

What the federal rule sets, and what it leaves to your state

Two federal sections do the structural work, and neither one mentions a missed appointment. 42 CFR 447.15 requires a state plan to limit Medicaid participation to providers who accept the agency's payment, plus any deductible, coinsurance or copayment the plan requires of the individual, as payment in full 1Ref 1Centers for Medicare & Medicaid Services, HHS (2023).Acceptance of State payment as payment in full.The federal payment-in-full condition on Medicaid participation: a state plan must limit participation to providers who accept the agency's payment plus any plan-required deductible, coinsurance or copayment as payment in full, and the fact that the section itself does not name missed appointments.. 42 CFR 431.107 makes the binding instrument a written agreement between the state Medicaid agency and each provider furnishing services under the plan 2Ref 2Centers for Medicare & Medicaid Services, HHS (2023).Required provider agreement.The structural point that the binding instrument is a written agreement between the state Medicaid agency and each participating provider, which is why the operative missed-appointment rule sits in a state document..

That leaves the operative question one level down. The federal condition is a floor on what participation means; the state agreement and the state manual say what the floor covers. New York's provider manual lists accepting payment under the Medicaid program as payment in full for the services rendered among the duties a provider agrees to by enrolling 3Ref 3New York State Department of Health, Office of Health Insurance Programs (2022).New York State Medicaid Program — Information for All Providers, General Policy.New York only: that enrolling in New York Medicaid commits a provider to accept payment under the Medicaid program as payment in full for the services rendered, and that this manual section does not itself address missed appointments.. That section stops there and says nothing about missed appointments, which is exactly the gap a state either fills or leaves open.

Payment in full is the phrase to search for. It is the hinge every state rule turns on, and the sentence a state amends when it names the missed-appointment charge.

Three state rules that foreclose the fee

Three state rules, all publicly posted, foreclose the fee in different words. Texas tells providers plainly that Medicaid clients cannot be charged for failing to keep an appointment 4Ref 4Texas Health and Human Services Commission / Texas Medicaid & Healthcare Partnership (2026).Texas Medicaid Provider Procedures Manual, Volume 1, General Information — Section 1: Provider Enrollment and Responsibilities.Texas only: that Texas Medicaid and Texas Medicaid clients cannot be charged for a client's failure to keep an appointment, that only billings for services provided are considered for payment, and that a provider billing a client outside the listed exceptions may be subject to exclusion from Texas Medicaid, quoted at the September 2026 edition.. Ohio names the missed-appointment fee inside its payment-in-full rule and cites the federal section as its authority 5Ref 5Ohio Department of Medicaid (2020).Rule 5160-1-13.1 | Medicaid recipient liability.Ohio only: that rule 5160-1-13.1 cites 42 CFR 447.15 as its authority and names the missed appointment fee among the charges a provider may not ask a recipient to bear, with carve-outs limited to Medicaid co-payments under rule 5160-1-09 and patient liability, and no billing of a recipient on a denied claim.. Washington bars the charge even where the patient signed an agreement to pay it 6Ref 6Washington State Health Care Authority (2025).WAC 182-502-0160 Billing a client.Washington only: that subsection (9) bars a provider from billing, demanding, collecting or accepting payment or a deposit for missed, canceled or late appointments regardless of any written, signed agreement to pay, and that record transfer, postage and concierge charges appear on the same list..

Texas writes it as a flat prohibition with a consequence attached. In accordance with current federal policy, the manual says, Texas Medicaid and Texas Medicaid clients cannot be charged for the client's failure to keep an appointment, and only billings for services provided are considered for payment 4Ref 4Texas Health and Human Services Commission / Texas Medicaid & Healthcare Partnership (2026).Texas Medicaid Provider Procedures Manual, Volume 1, General Information — Section 1: Provider Enrollment and Responsibilities.Texas only: that Texas Medicaid and Texas Medicaid clients cannot be charged for a client's failure to keep an appointment, that only billings for services provided are considered for payment, and that a provider billing a client outside the listed exceptions may be subject to exclusion from Texas Medicaid, quoted at the September 2026 edition.. A provider who attempts to bill or recover money from a client outside the listed exceptions may be subject to exclusion from Texas Medicaid 4Ref 4Texas Health and Human Services Commission / Texas Medicaid & Healthcare Partnership (2026).Texas Medicaid Provider Procedures Manual, Volume 1, General Information — Section 1: Provider Enrollment and Responsibilities.Texas only: that Texas Medicaid and Texas Medicaid clients cannot be charged for a client's failure to keep an appointment, that only billings for services provided are considered for payment, and that a provider billing a client outside the listed exceptions may be subject to exclusion from Texas Medicaid, quoted at the September 2026 edition.. No dollar penalty appears there.

Ohio shows its reasoning. Rule 5160-1-13.1 cites 42 CFR 447.15 as its authority and then names the charge inside the payment-in-full clause: a provider shall not ask a Medicaid recipient to share in the cost through a deductible, coinsurance, co-payment, missed appointment fee or other similar charge 5Ref 5Ohio Department of Medicaid (2020).Rule 5160-1-13.1 | Medicaid recipient liability.Ohio only: that rule 5160-1-13.1 cites 42 CFR 447.15 as its authority and names the missed appointment fee among the charges a provider may not ask a recipient to bear, with carve-outs limited to Medicaid co-payments under rule 5160-1-09 and patient liability, and no billing of a recipient on a denied claim.. The carve-outs are narrow: Medicaid co-payments under rule 5160-1-09 and patient liability. A denied claim opens no door either.

Washington closes the door most practices reach for first. Subsection (9) opens with the words regardless of any written, signed agreement to pay, then forbids a provider to bill, demand, collect or accept payment or a deposit from a client for the items it lists 6Ref 6Washington State Health Care Authority (2025).WAC 182-502-0160 Billing a client.Washington only: that subsection (9) bars a provider from billing, demanding, collecting or accepting payment or a deposit for missed, canceled or late appointments regardless of any written, signed agreement to pay, and that record transfer, postage and concierge charges appear on the same list.. Missed, canceled, or late appointments is one of them, so a late cancellation falls under the same bar.

But three states are three states.

No fifty-state survey stands behind this page, and none of these rules tells you anything about a fourth state. What they show is the shape of the prohibition: it sits in the section about billing the client, it follows from payment in full, and in one state it survives a signature the patient gave you.

Why Medicare is the opposite case

Medicare runs the other way, and the contrast is the reason this question keeps coming up. CMS policy allows physicians and suppliers to charge Medicare beneficiaries for missed appointments, provided that they do not discriminate against Medicare beneficiaries in doing so 7Ref 7Centers for Medicare & Medicaid Services (2024).Medicare Claims Processing Manual, Chapter 1 — General Billing Requirements (CMS Pub. 100-04).The Medicare contrast in chapter 1, section 30.3.13: that CMS policy allows charging Medicare beneficiaries for missed appointments provided the practice does not discriminate against them, that the amount must equal what non-Medicare patients are charged, and that the charge is for a missed business opportunity rather than a service, with Medicare paying nothing toward it.. The condition is equal application: the amount charged a Medicare beneficiary for a missed appointment must be the same as the amount charged non-Medicare patients 7Ref 7Centers for Medicare & Medicaid Services (2024).Medicare Claims Processing Manual, Chapter 1 — General Billing Requirements (CMS Pub. 100-04).The Medicare contrast in chapter 1, section 30.3.13: that CMS policy allows charging Medicare beneficiaries for missed appointments provided the practice does not discriminate against them, that the amount must equal what non-Medicare patients are charged, and that the charge is for a missed business opportunity rather than a service, with Medicare paying nothing toward it..

CMS treats that charge as one for a missed business opportunity rather than for a service, which is why the program pays nothing toward it and the beneficiary carries the whole amount 7Ref 7Centers for Medicare & Medicaid Services (2024).Medicare Claims Processing Manual, Chapter 1 — General Billing Requirements (CMS Pub. 100-04).The Medicare contrast in chapter 1, section 30.3.13: that CMS policy allows charging Medicare beneficiaries for missed appointments provided the practice does not discriminate against them, that the amount must equal what non-Medicare patients are charged, and that the charge is for a missed business opportunity rather than a service, with Medicare paying nothing toward it..

The trap is inheritance. A practice already running no-show fees under the Medicare rule tends to assume Medicaid works the same way, since both arrive through the same front desk and both sound federal. They are separate programs under separate rules, and the Medicaid rule is written by your state.

Two neighboring cases are settled by nothing cited here: a patient covered under CHIP, the children's program, and the Medicare-covered side of a visit for a patient eligible for both Medicare and Medicaid. Treat both as their own lookups.

How to find your own state's rule

Open three documents, in this order, and the answer usually surfaces inside an hour: your state Medicaid agency's provider manual, searched for its section on billing the client; the state administrative code chapter that manual cites; and the provider agreement you signed at enrollment, the instrument that binds you 2Ref 2Centers for Medicare & Medicaid Services, HHS (2023).Required provider agreement.The structural point that the binding instrument is a written agreement between the state Medicaid agency and each participating provider, which is why the operative missed-appointment rule sits in a state document.. If all three are silent, the question is open.

1. Search the manual for billing the client, client billing, or recipient liability. Those are what Texas, Ohio and Washington call the same section, and a state with a rule keeps it there. 2. Read the administrative code section the manual cites rather than the manual's summary. Ohio is the example: the fee is named in the rule, and a summary that drops the phrase reads as silence. 3. Write the effective or edition date beside the quote in your policy file. The Texas manual is revised monthly and is quoted here at its September 2026 edition. Washington's subsection was amended effective October 5, 2025, and Ohio's rule has been effective since January 1, 2020. 4. If the patient is in a Medicaid managed-care plan, read that plan's participation agreement too. Those contracts are not public, so no article can tell you what yours says. 5. If manual and code are both silent, put the question to the agency's provider relations unit in writing and file the reply with the policy.

The test before a new fee turns on the same lookup. Before a charge goes onto your fee schedule, ask which payers permit it and which forbid it, one payer at a time.

What to do with the policy you already have

Keep the policy and scope it by payer. A no-show fee can stay in your practice policy for the patients whose coverage permits it while coming off entirely for Medicaid beneficiaries, and in the three states above that scoping is what the rule requires. Write the exclusion into the policy document, so the biller does not have to remember it as a claim goes out.

The Medicare condition speaks to the amount charged, and it does not address a payer group a practice cannot bill at all. Confirm with your Medicare contractor's published guidance before assuming that excluding Medicaid patients breaks that condition.

The operational half sits in the schedule. Common conventions in small practices are a reminder in the days before the visit, a waitlist that can take a vacated slot, missed visits documented in the chart and raised with the patient as a clinical matter, and a written attendance policy shown at intake. None of that recovers the lost hour, and it is what practices use in place of a charge they cannot make.

A neighboring question arrives in the same conversation with a different answer: whether a practice may run a sliding scale for medicare and medicaid beneficiaries at all, which turns on inducement rules instead. That is its own lookup.

The rules settle whether the charge may be made. They leave open what your schedule does instead, and whether a Medicaid panel of the size you carry still works with the no-show fee off the table. That decision has your own numbers in it.