Should you choose the Medicare or Medicaid Incentive plan?

Deciding whether to opt for Medicare vs. Medicaid incentives will involve “running the numbers” once all the details of the programs are available as well as how well prepared you are in advance. Below is a comparison chart of the primary components of the Medicare and Medicaid Incentive plans.




Eligibility linked with threshold patient volumes?

No threshold Medicare patient volumes to qualify for additional Medicare incentives

Have patient volume of at least 30% attributable to Medicaid patients.

Meaningful use required each year?

Yes - Physicians must purchase or lease the system, integrate it into your practice and be “meaningfully” using it before you’ll receive any money. Then they must successfully demonstrate meaningful use for each year of participation in the program.

No - Medicaid eligible professionals can receive incentive payments for adopting, implementing or upgrading (A/I/U) to certified EHR technology in the first year of participation.

Must successfully demonstrate meaningful use in subsequent participation years.

Meaningful Use Definition

MU definition is common for Medicare

States can adopt certain additional requirements for MU

Year 1 max incentive payment



Incentives in Additional Years

$12K, $8K, $4K and $2K for the next four years for those starting to receive benefits in 2011

Physicians will be eligible to receive up to $8,500 annually for five additional years to support the "meaningful use" of EHRs

Maximum Incentives

Maximum reimbursement of $44K over a period of 5 years ($48.4K in HPSA) (For calendar years 2011–2016)

Reimbursement of up to 85% of allowable EHR costs not to exceed a maximum of $63,750  per provider over six years (for calendar years 2011-2021)

Starting year

2011 (Confirmed)

2011 (Probable)

Latest start date to maximize incentives



Incentive Expiry

No Medicare incentive for those who are meaningfully using an EHR after 2014; Last payment made in 2016

No Medicaid incentive payment to be made after 2021 or for more than 5 years

Additional Incentive for HPSA

10% additional


Linked to Allowed Charges?

Yes - $24000 in Medicare Allowed Charges (75% of $24K = $18K) required to maximize reimbursement

No – Medicaid Incentive payment not linked with Allowed Charges.

Penalties for not demonstrating meaningful use of a certified EHR

Begins to cut payments to doctors in 2015

No such punitive cuts

Implemented by

Federal Government (option available nationally)

State Governments will implement voluntarily (may not be available in all States). Check the latest update here.


Applicable to

Only physicians, subsection(d) hospitals and CAHs

5 types of EPs, acute care hospitals (including CAHs) and children’s hospitals

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