Medicare and Medicaid Differences
The chart below outlines the primary differences between the Medicare and Medicaid EHR Incentive Programs. All entries apply to both EPs and EHs, unless otherwise noted.
Click on the CMS PI link CMS Promoting Interoperability Programs and select the appropriate Program year from the menu section on the left side of the page for eligibility requirements.
| Medicare EHR Incentive Program | Medicaid EHR Incentive Program |
|---|---|
| Run by CMS | Run by each state's Medicaid agency |
*EP payments occur over five consecutive years
EH payments occur over four consecutive years |
*EP payments occur over six years (does not have to be consecutive years) EH payments occur over three to six years (varies by state; does not have to be consecutive years) |
| Program runs from 2011 through 2016 | Program runs from 2011 through 2021 |
| Payment adjustments begin in 2015 for eligible EPs/EHs who decide not to participate | No Medicaid payment adjustments |
| Must demonstrate MU every year to receive incentive payments | Can receive an incentive payment for adopting, implementing, or upgrading EHR technology in the first year; must continue to demonstrate meaningful use to receive incentive payments in subsequent years. |
| No patient volume requirement | Pediatricians must have a minimum Medicaid patient volume of 20 percent; all other EPs must have a minimum Medicaid patient volume of 30 percent. (EPs who practice predominately at a Tribal/Urban/FQHC/RHC may use a "needy individual" calculation to reach their 30 percent patient volume.) EHs must have a Medicaid patient volume of at least 10 percent. Learn how to calculate patient volume. |
*EPs can receive up to $44,000 through the Medicare EHR Incentive Program over a five-year period or up to $63,750 through the Medicaid EHR Incentive Program over a six-year period.
EHR incentives for EHs are based on several variables, such as length of stay and number of beds. Use the hospital calculator [XLS - 151 KB] to estimate incentive amounts in each program.
