Medicare vs. Medicaid Incentives

How to Choose between Medicare and Medicaid Incentives

EHR incentives can be earned through Medicare or Medicaid*. Providers must identify the program through which they will participate—this is an important decision because they will be able to switch between programs only one time after they receive their first incentive payment. Although the requirements are similar, there are important differences to consider when making the selection.

Physicians who are eligible for both programs will likely find participation under Medicaid to be a preferable option because the incentives are higher, the first year provides rewards for adoption/purchase without requiring demonstration of meaningful use, and the program offers more flexibility in terms of time frames.

To participate under Medicaid, however, a provider must have a practice that is 30% Medicaid (20% for pediatricians), based on number of patient encounters. Some providers are eligible only under Medicaid—nurse practitioners, certified nurse-midwives, dentists, and physician assistants who practice in a Federally Qualified Health Center or rural health clinic that is led by a physician assistant.

Major Differences between Medicare and Medicaid

	MEDICARE	MEDICAID
Maximum incentive	$44,000 over 5 years (+10% for EPS in HPSAs)	$63,750 over 6 years ($42,500 for pediatricians with 20–30% Medicaid)
First payment year	Requires meaningful use	$21,250 for adoption, implementation, upgrading to EHR ($14,167 for pediatricians with 20–30% Medicaid)
Latest start time to earn maximum	2012 (Must start by 2014 to qualify for any incentives)	2016
Last payment year	2016	2021
Eligibility for concurrent ePrescribing bonus (MIPPA)	No	Yes

 

*Not all states have their EHR incentive programs ready to go yet. Forty-three states have launched as of March, 2012; others are expected later in the year or in 2012. The Medicaid programs are run by individual states, so requirements and processes may vary somewhat from the Medicare program and from each other. CMS maintains a list of launch dates and websites by state.

For information specific to the EHR incentives under Medicaid, the following additional resources are available: CMS Medicaid State Information and Medicaid FAQ.

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