Eligible Hospitals

The following are considered eligible hospitals (EHs):

Acute Care Hospitals (including Cancer and Critical Access Hospitals)

  • Average Length of Stay (ALOS) must be 25 days or less
  • Must have a CMS Certification Number (CCN) where the last four digits fall in the range of 0001-0878 or 1300-1399.

Children’s Hospitals

  • Must have a CMS Certification Number (CCN) where the last four digits fall in the range of 3300-3399.

Patient Threshold Requirements:

In order to participate in the Medicaid EHR Incentive Payment Program, Acute Care Hospitals (including Cancer and Critical Access Hospitals) must meet or exceed a Medicaid Patient Volume Threshold of 10% over a continuous 90 day period from the previous federal fiscal year. Children’s Hospitals are not required to meet a minimum Medicaid Patient Volume Threshold.

A Children’s Health Insurance Program (CHIP) reduction factor of 2.65% must be applied to an eligible hospital’s Medicaid Patient Volume in order to fulfill a CMS requirement stating that CHIP patients may not be included in Medicaid Patient Volume Threshold.

Incentive Payments:

Eligible hospital incentive payments are determined using the following EHR incentive aggregate payment equation: {(overall EHR amount) x (Medicaid Share)}.

The Medicaid EHR Incentive Payment Program plans to distribute eligible hospital incentive payments over a three year period.

  • Year 1: 50% of the hospitals aggregate incentive payment
  • Year 2: 30% of the hospitals aggregate incentive payment
  • Year 3: 20% of the hospitals aggregate incentive payment

The Executive Office of Health and Human Services (EOHHS)/MassHealth has created a Medicaid EHR Incentive Payment Estimation Tool for eligible hospitals.  This helpful resource can be found by visiting the Tools & Resources section of our website.

Dual Eligibilty:

If a hospital is dually eligible, they are eligible to receive payments from both the Medicare and Medicaid EHR Incentive Payment Program in the same year. If approved as a meaningful user of federally certified EHR technology by Medicare, eligible hospitals are “deemed” a meaningful user by Medicaid.

For more information regarding eligibility requirements for hospitals, please visit the Tools & Resources section of our website.