Eligibility

Who is a Medicaid Eligible Provider?

Eligible Providers (EPs)

• Physicians
• Nurse practitioners (NPs)
• Certified Nurse Midwives (CNMs)
Dentists
• Physician Assistants (PAs) when practicing at an FQHC/RHC
that is so led by a PA

Eligible Hospitals

• Acute care hospitals (including CAHs and cancer hospitals)
• Children’s hospitals

Eligibility: Patient Volume

Physicians – 30%
Pediatricians – 20%
Dentists – 30%
CNMs – 30%
PAs when practicing at an FQHC/RHC that is so led by a PA – 30%
NPs – 30%
Acute care hospitals – 10%
Children’s hospitals – No requirement

Eligibility: Practices Predominantly & Needy Individuals

EP is also eligible when practicing predominantly in FQHC/RHC providing care to needy individuals Practicing predominantly is when FQHC/RHC is the clinical
location for over 50% of total encounters over a period of 6 months in the most recent calendar year Needy individuals (specified in statute) include:
• Medicaid or CHIP enrollees;
• Patients furnished uncompensated care by the provider;
or
• furnished services at either no cost or on a sliding scale.

Payments: EP Adoption Timeline

2011 $21,250
2012 $8,500 $21,250
2013 $8,500 $8,500 $21,250
2014 $8,500 $8,500 $8,500 $21,250
2015 $8,500 $8,500 $8,500 $8,500 $21,250
2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250
2017 $8,500 $8,500 $8,500 $8,500 $8,500
2018 $8,500 $8,500 $8,500 $8,500
2019 $8,500 $8,500 $8,500
2020 $8,500 $8,500
2021 $8,500
Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750