Medicaid Eligible Providers

Eligible Medicaid providers can qualify for up to $63,750 per provider over six years within calendar years 2011 to 2021 in the state they provide services. This begins as early as 2011 with implementation of many state health IT plans.¹ States voluntarily participate and may continue to initiate incentive programs through 2012. The last year to initiate participation in the Medicaid EHR Incentive Program is 2016.

For the most recent list of states with open registration for Medicaid EHR incentive programs please visit the CMS website here.

Medicaid eligible professionals must adopt, implement, or upgrade (AIU), or demonstrate MU of certified EHR technology in the first year of participation, and successfully demonstrate MU in subsequent participation years.² Eligibility for a provider is determined by patient volume with a minimum defined as patients who are either covered by Medicaid or who receive uncompensated care, or for whom charges are prospectively adjusted according to their ability to pay the Medicaid threshold. Medicaid incentive funds are subject to 30% patient volume overall and 20% for pediatricians.³ Eligible Medicaid providers include:

• Physicians: Doctor of Medicine (MD) or Doctor of Osteopathy (DO)
  • Pediatricians have special eligibility and payment rules
• Dentists: Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DDM)
• Doctor of Optometry (OD) [in some specific states]
• Nurse Practitioners (NPs)
• Certified Nurse Midwives (CNMs)
• Physician Assistants (PAs)
  • Who are practicing at a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is “so led” by a PA
  • “So led” means that a PA is the primary provider at the clinic or is the Medical/Clinical Director at that practice or is the owner of the Rural Health Clinic (RHC)^4,5

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