Medicaid Eligible Professional

The Medicaid EHR incentive program is voluntarily offered and administered by States and territories. States can start offering their program to eligible professionals (EPs) as early as 2011. The program continues through 2021. Eligible professionals can participate for 6 years throughout the duration of the program. The last year to begin participation is 2016.

The incentives are based on the individual providers. Therefore, if you are part of a practice, each eligible professional may qualify for an incentive payment provided they meet the requirements for the program. Each EP is only eligible for one incentive payment each year, regardless of how many practices or locations they provide services.

Eligibility for Medicaid EHR Incentive Program - Eligible Professionals (EPs)

Under the Medicaid EHR incentive program, EPs include the following:

*   Physicians (Pediatricians have special eligibility and payment rules)

*   Nurse Practitioners (NPs)

*   Certified Nurse-Midwives (CNMs)

*   Dentists

*   Physician Assistants (PAs) who provide services in a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) that is led by a PA 


Medicaid eligible professionals must also meet patient volume criteria, providing services to those attributable to Medicaid or, in some cases, needy individuals. To see if you may be eligible, click the Eligibility link on the left.


NOTE: Medicaid eligible professionals may not be hospital-based. 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.


Medicaid physicians who are also eligible as a Medicare EP must choose between the Medicare and Medicaid incentive programs when they register. Not sure which program to register? Find more information in the Eligibility link on the left.

Participating in the EHR Incentive Program and Other Current CMS Incentive Programs

This is a new program, and it is separate from other active CMS incentive programs, such as Physicians Quality Reporting Initiative (PQRI) and e-Prescribing. If you participate as a Medicaid EP, you may participate in both the Medicaid EHR incentive program and the e-Prescribing program at the same time, as long as you meet the eligibility requirements for both programs. However, if you participate as a Medicare eligible professional, you cannot receive incentive payments from both the Medicare EHR incentive program and the e-Prescribing program in the same year. Physicians can participate in the Physicians Quality Reporting Initiative (PQRI) at the same time as the Medicare and Medicaid EHR incentive programs, as long as they meet eligibility requirements for both programs. More information is available in the Medicare Eligible Professional tab on the left.

Criteria for Qualifying for an Incentive

The qualification criteria for incentives (i.e., meeting specified HIT standards, policies, implementation specifications, timeframes, and certification requirements) are still in development, and will be defined through regulation and additional guidance materials. However, CMS generally expects that under Medicare, “meaningful EHR users” would demonstrate each of the following: meaningful use of a certified EHR, the electronic exchange of health information to improve the quality of health care, and reporting on clinical quality and other measures using certified EHR technology. Medicaid programs will determine their own requirements in line with the Medicaid-related provisions of the Recovery Act. Funds will be distributed through Medicare and Medicaid incentive payments to EPs and hospitals who are “meaningful EHR users.” CMS intends to publish a proposed rule in late 2009 to propose a definition of meaningful use of certified Electronic Health Records (EHR) technology and establish criteria for the incentives programs. CMS is working extensively with the Office of the National Coordinator for Health Information Technology (ONC) to identify the proposed criteria.

Incentive Payments

To qualify for Medicaid incentive payments, Medicaid eligible professionals must adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology in the first year of participation. Medicaid EPs must demonstrate meaningful use in years 2-6 of participation. For calendar years 2011-2021, participants can receive up to $63,750 over 6 years under the Medicaid EHR incentive program. Incentive payments are made by the State based on the calendar year. 

  Medicaid EP Qualifies to Receive First Payment in 2011 Medicaid EP Qualifies to Receive First Payment in 2012 Medicaid EP Qualifies to Receive First Payment in 2013 Medicaid EP Qualifies to Receive First Payment in 2014 Medicaid EP Qualifies to Receive First Payment in 2015 Medicaid EP Qualifies to Receive First Payment in 2016
Payment Amount in 2011 $21,250.00 $0.00 $0.00 $0.00 $0.00 $0.00
Payment Amount in 2012 $8,500.00 $21,250.00 $0.00 $0.00 $0.00 $0.00
Payment Amount in 2013 $8,500.00 $8,500.00 $21,250.00 $0.00 $0.00 $0.00
Payment Amount in 2014 $8,500.00 $8,500.00 $8,500.00 $21,250.00 $0.00 $0.00
Payment Amount in 2014 $8,500.00 $8,500.00 $8,500.00 $8,500.00 $21,250.00 $0.00
Payment Amount in 2015 $8,500.00 $8,500.00 $8,500.00 $8,500.00 $8,500.00 $21,250.00
Payment Amount in 2016 $8,500.00 $8,500.00 $8,500.00 $8,500.00 $8,500.00 $8,500.00
Payment Amount in 2017 $0.00 $8,500.00 $8,500.00 $8,500.00 $8,500.00 $8,500.00
Payment Amount in 2018 $0.00 $0.00 $8,500.00 $8,500.00 $8,500.00 $8,500.00
Payment Amount in 2019 $0.00 $0.00 $0.00 $8,500.00 $8,500.00 $8,500.00
Payment Amount in 2020 $0.00 $0.00 $0.00 $0.00 $8,500.00 $8,500.00
Payment Amount in 2021 $0.00 $0.00 $0.00 $0.00 $0.00 $8,500.00
TOTAL Incentive Payments $63,750.00 $63,750.00 $63,750.00 $63,750.00 $63,750.00 $63,750.00

Important! All Medicare providers will have a payment reduction in 2015 if they are not demonstrating meaningful use. For example, if you are a physician and accept both Medicare and Medicaid, you must be demonstrating meaningful use by 2015 (in either the Medicare or the Medicaid EHR incentive program) or you will have a Medicare fee-schedule reduction for all your Medicare claims. The payment reduction for Medicare Fee-for-Service physicians starts at 1% and increases up to 5% for every year that you are not demonstrating meaningful use. Hospital-based physicians are not subject to possible payment reductions.