Medicaid EHR Incentive Program
Who qualifies to participate?
You qualify to participate if any of the following applies to you:
- 30% of patient volume is Medicaid patients
- Pediatricians qualify if 20% of patient volume is Medicaid patients, but at a reduced incentive
- For providers practicing predominately in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) and have a minimum 30% patient volume attributable to needy individuals (Medicaid, CHIP, Sliding Scale, Charity Care)
- Medicaid providers cannot participate in both the Medicare and Medicaid EHR Incentive Programs like Medicaid hospitals.
- The incentive program began in 2011 and will run through 2021. The last year that a provider can participate is 2016.
- The Merit-Based Incentive Payment System (MIPS) does not currently impact or make changes to the Medicaid EHR Incentive Program. MIPS will impact providers participating in the Medicare EHR Incentive Program beginning in CY 2017.
Read more about the Merit-Based Incentive Payment System (MIPS)
How to Calculate Medicaid Patient Volume:
Medicaid patient volume is determined by the following calculation for any 90-day period in the preceding calendar year:
| Total Medicaid Patients Seen | × 100 = Percentage |
| Total Patients Seen |
If Medicaid patient volume is 30% or more (or 20% for Pediatricians), you qualify to participate in the Incentive Program.
Incentive Payment and Meaningful Use Demonstration Timeline If You Have Not Demonstrated Meaningful Use in Previous Years For providers (including pediatricians) with Medicaid patient volumes of 30% or more: Pediatricians with Medicaid volumes between 20% – 29% will qualify for 2/3 of the total incentive payment:
Medicare Penalties Begin in 2015 Medicaid providers who also treat Medicare patients will have a payment adjustment to Medicare reimbursement starting in 2015 if they do not successfully demonstrate meaningful use. Penalty Scheduled Based on Annual Medicare Reimbursement if Meaningful Use is not demonstrated: Penalty Scheduled Based on Annual Medicare Reimbursement if Meaningful Use is demonstrated starting 2015:
2016 Modified Stage 2 of Meaningful Use 2016 Modified Stage 2 Reporting Period
2017 Modified Stage 2 of Meaningful Use 2017 Modified Stage 2 Reporting Period
If You Have Demonstrated Meaningful Use in Previous Years If you have demonstrated Meaningful Use in previous years, providers in the Medicaid EHR Incentive Program can receive up to $63,750. There are no penalties to providers for not meeting Meaningful Use. However, providers that also see Medicare patients that do not meet Meaningful Use will receive a payment adjustment to Medicare reimbursement starting in 2015. If your first year of demonstration was in 2011, 2012, 2013 or 2014, then your participation timeline, reporting periods and schedule of incentive payments for Adopting, Implementing or Upgrading Certified EHR Technology in Year 1 are as follows: 
Attestation Period
Attestation of meaningful use is reported directly with the provider’s State Medicaid Agency. Also, each State Medicaid Agency has its own attestation deadlines and schedule for incentive payments.