Eligibility
There are differences in the eligibility between Medicare, Medicare Advantage and Medicaid for eligible professionals and hospitals. Learn more about the eligibility requirements for each incentive program in the Medicare Eligible Professionals, Medicaid Eligible Professionals and Hospitals tabs to the left. In order to participate in the Medicare and Medicaid EHR incentive programs, health professionals and hospitals must meet the eligibility criteria defined by law. Eligibility groups are listed below.
 
ELIGIBILITY FOR INDIVIDUAL PROVIDERS - ELIGIBLE PROFESSIONALS (EPs)


The incentives for eligible professionals are based on individual providers. Therefore, if you are part of a practice, each eligible professional may qualify for an incentive payment provided they successfully demonstrate meaningful use. Each EP is only eligible for one incentive payment each year, regardless of how many practices or locations they provide services. 
 
Medicare: A Medicare EP is defined as a doctor of medicine or osteopathy, doctor of dental surgery or dental medicine, doctor of podiatry, doctor of optometry or a chiropractor who is not hospital-based. 

NOTE: A Medicare EP is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting. 

 
Medicaid: A Medicaid EP is defined as a physician, nurse practitioner, certified nurse-midwife, dentist, or physician assistant who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant. To qualify for an EHR incentive payment, a Medicaid EP must not be hospital-based and must meet one of the following criteria:
  • Have a minimum 30% Medicaid patient volume*
  • Have a minimum 20% Medicaid patient volume, and is a pediatrician*
  • Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals
NOTE: A Medicaid EP is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting.

* Children's Health Insurance Program (CHIP) patients do not count towards the Medicaid patient volume criteria.
EPs Eligible for Both Programs




If you are an EP that is eligible for both the Medicare and the Medicaid incentive programs, you can only participate in one program, not both. You will need to select which program you want to participate when you register. Here are the general differences:
 
Medicare EHR Incentive Program
Medicaid EHR Incentive Program
Can participate as soon as the federal program launches
Can participate once my state offers the program (check with your state for expected launch date)
Can receive up to $44,000.00 in incentives, and up to $48,400.00 if practicing in a Health Provider Shortage Area
Can receive up to $63,750.00 in incentives
Required to demonstrate meaningful use of certified EHR technology every year to qualify for payment
Can qualify for payment for adopting, implementing, upgrading or demonstrating meaningful use of certified EHR technology in first participation year. Required to demonstrate meaningful use in each subsequent year to qualify for payment
Must participate by the second year to receive the maximum incentive payment
Must participate by 2016 to receive the maximum incentive payment


NOTE: Before 2015, an eligible professional may switch between the programs one time after the first incentive payment is initiated.


Medicare Advantage Organization Eligible Professionals: The Medicare Advantage EHR incentive program is structured differently than the Medicare EHR incentive program for Medicare Fee-for-Service providers. Click on the Medicare Advantage tab to the left for more information.
 
ELIGIBILITY FOR HOSPITALS - ELIGIBLE HOSPITALS
 
Medicare: An eligible hospital for Medicare incentive payments is a "subsection (d) hospital" that is paid under the hospital inpatient prospective payment system. Hospitals must be located in one of the 50 states or the District of Columbia. Critical Access Hospitals and Medicare Advantage Hospitals are also eligible to receive Medicare EHR payments provided they demonstrate meaningful use of certified EHR technology.


Medicaid: Acute care hospitals (including Critical Access Hospitals) with at least 10% Medicaid patient volume, as well as children's hospitals (no Medicaid volume requirements) may be eligible for Medicaid EHR incentive payments.

 
NOTE: Some hospitals (e.g. Medicaid acute care hospitals that are also Medicare subsection (d) hospitals) may receive incentive payments from both Medicare and Medicaid if it meets all eligibility criteria.