Becoming a Medicaid provider: questions, answered

Enrolling with your state Medicaid agency so it can pay your agency for covered services to eligible clients. Enrollment includes disclosures, screening and a provider agreement.

A home and community-based services program that lets a state provide long-term services and supports at home or in the community instead of an institution. States choose the target groups, the services and how many people each waiver serves.

Depending on the state and program, services can include personal care, homemaker, home health aide, respite, adult day health and case management. Check your state’s programs for what it covers.

A system that electronically records the type of service, the person receiving it, the date, the location, the person providing it, and the start and end times. Federal law requires states to use it for Medicaid personal care and home health visits.

At minimum, license verification and federal database checks. Provider types screened at moderate risk also get a site visit; high-risk types add a criminal background check and fingerprints. Your state decides the risk level.

States must collect an applicable application fee before signing a provider agreement, with exceptions such as providers already enrolled in Medicare or another state’s Medicaid program. Ask your state about the current amount.

Often, but not always. Under federal HIPAA rules, a health care provider that conducts standard electronic transactions, such as electronic claims, must get an NPI. Some non-medical service providers are not health care providers under HIPAA, and states handle their identifiers differently. Ask your state Medicaid agency what it requires for your provider type. NPIs are issued through NPPES.

We do not publish timelines because they vary by state and by application. Ask your state Medicaid agency.

If your state delivers your service through managed care plans, each plan credentials providers under a documented process that follows the state’s uniform policy.

States must revalidate every provider’s enrollment at least every five years. Your state may ask sooner.

Home Care Agency Blueprint, which sells courses and coaching to people starting home care agencies. We say so on every page so you can weigh our perspective.