Medicaid vs Medicare

Incentive Program Differences

For eligible providers, there is a difference between the Medicare EHR Incentive and the Medicaid EHR Incentive programs.

The Medicare EHR Incentive Program, administered by CMS, will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology.

The Medicaid EHR Incentive Program, administered at the state level, will provide incentive payments to eligible professionals, eligible hospitals, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years.

Below is a quick comparison between the two programs to assist eligible providers.

Medicaid vs. Medicare Comparison Chart

	Medicaid	Medicare
Total Incentive	_{Up to $63,750}	Up to $44,000
Total Years	6	5
First Year's Payment	$21,500	$18,000 (for 2011 or 2012)
Subsequent Years	$8,500/year	Steps down from $12,000 to $2,000
Patient Volume Reqs	Significant Medicaid Patient Volume	Proportional to Part B Allowable Claims
Adopt / Implement / Upgrade	Year 1 Only	No
Meaningful Use	Years 2-6	All Years
Continuous Participation	No	Yes
Eligible Provider Types	Physician, Nurse Practitioner, Dentist, Physician Assistant* (under special circumstances)	Doctor of medicine or osteopathy, Doctor of oral surgery or dental medicine, Doctor of podiatric medicine, Doctor of Optometry, Chiropractor

As a provider for the Medicare and Medicaid EHR Incentive Program, see the basics.

Hospitals may receive incentive payments in the same payment year from both Medicaid and Medicare if they meet all eligibility criteria.

For more information on the Medicare EHR Incentive Program, visit the Center for Medicare and Medicaid Services website.