Credentialing By State

Credentialing And Payer Enrollment, State By State

Medicaid is the one part of credentialing that genuinely changes at the state line. Commercial carriers mostly follow your license, so a national contract reaches every state you are licensed in. Medicaid does not work that way. Each state runs its own program, its own enrollment system, and its own rules about who you contract with after you enroll.

That is what these pages are for. Each one covers the real program name, how care is delivered in that state, which plans matter, where behavioral health is carved out to a separate vendor, what the state actually requires from you, and any statutory clock a carrier has to answer within. Pick your state and you will see the specific path rather than general advice.

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Start With How The State Delivers Care

The delivery model decides how much work Medicaid is.

In a fee-for-service state you enroll once and you are done. In a managed care state, enrolling with the agency only makes you eligible; you still contract with each plan separately, and each plan runs its own clock. Getting that wrong is the most common reason a provider believes they are in-network months before they actually are.

Managed Care Organizations

21 States

You enroll with the state, then contract with each health plan on its own timeline. Enrolling is not the same as being in-network.

ArizonaArizona Health Care Cost Containment System (AHCCCS)DelawareDelaware Medical Assistance Program (DMAP)FloridaFlorida Medicaid: Statewide Medicaid Managed Care (SMMC)HawaiiMed-QUEST (Hawaii Medicaid). Managed care is delivered through the QUEST Integration (QI) program.IllinoisIllinois Medical Assistance Program (Medicaid)IowaIowa Medicaid KansasKanCare KentuckyKentucky Medicaid (the Medical Assistance Program)LouisianaLouisiana Medicaid NebraskaNebraska Medicaid NevadaNevada Medicaid New HampshireNew Hampshire Medicaid New JerseyNJ FamilyCare (New Jersey Medicaid)New MexicoTurquoise Care (New Mexico Medicaid)New YorkNew York State Medicaid Rhode IslandRhode Island Medicaid TennesseeTennCare (Tennessee Medicaid)TexasTexas Medicaid: STAR VirginiaCardinal Care (Virginia Medicaid)WashingtonWashington Apple Health (Medicaid)West VirginiaWest Virginia Medicaid

Mixed

18 States + DC

Part of the population sits in managed care and part stays fee-for-service. Which one your patients fall into changes what you have to do.

ArkansasArkansas Medicaid CaliforniaMedi-Cal District of ColumbiaDC Medicaid (Department of Health Care Finance)GeorgiaGeorgia Medicaid and PeachCare for Kids (CHIP). Managed care is delivered through Georgia Families IdahoIdaho Medicaid IndianaIndiana Health Coverage Programs (IHCP)MarylandMaryland Medical Assistance Program (Medicaid)MassachusettsMassHealth (Massachusetts Medicaid and CHIP)MichiganMichigan Medicaid and the Healthy Michigan Plan (the Comprehensive Health Care Program on the managed care side)MinnesotaMinnesota Health Care Programs (MHCP)MississippiMississippi Medicaid MissouriMO HealthNet (Missouri Medicaid)North CarolinaNC Medicaid (including NC Health Choice)North DakotaNorth Dakota Medicaid (including North Dakota Medicaid Expansion)OhioOhio Medicaid (managed care delivered by the Next Generation managed care plans)OklahomaSoonerCare (Oklahoma Medicaid)South CarolinaHealthy Connections Medicaid UtahUtah Medicaid WisconsinBadgerCare Plus and Wisconsin Medicaid (including Medicaid SSI)

Fee-For-Service

8 States

The state pays you directly. You enroll once with the Medicaid agency and there is no plan layer to contract with separately.

AlabamaAlabama Medicaid AlaskaAlaska Medical Assistance (Alaska Medicaid)ConnecticutConnecticut Medical Assistance Program (CMAP) / HUSKY Health MaineMaineCare MontanaMontana Healthcare Programs (Montana Medicaid and Healthy Montana Kids Plus)South DakotaSouth Dakota Medicaid VermontVermont Medicaid WyomingWyoming Medicaid

Special Structures

3 States

Three states route Medicaid through a structure of their own, so who actually holds your contract is regional or county rather than statewide.

OregonOregon Health Plan (OHP). Regional coordinated care organizations hold the contract, so the county your patients live in decides who you contract with.ColoradoHealth First Colorado (Colorado’s Medicaid program). Regional accountable entities manage behavioral health, and physical and behavioral health run on different rails.PennsylvaniaPennsylvania Medical Assistance (Medicaid). Counties run their own behavioral health plans, so the route in is local rather than statewide.

What We Stand Behind

If something we delivered does not work the way we said it would, we fix it at no charge for 30 days after delivery, including one stabilization review. That covers our own work. A new request, another payer or provider, a change of scope, or a new build is quoted separately. You will not get an invoice for correcting our mistake.

Built to keep working after we are done. Everything we set up is built for the practice you are growing into, not only the one you have today. Adding a provider, a location, or another payer should be a configuration step rather than a rebuild. When the engagement ends you own the accounts, the documentation, and the systems, and they keep running without us.

What We Do With This

You buy online, fill out one intake, and we prepare every application from it. You review and sign, we submit and follow up, and you watch each payer move in Command Suite, which comes with every package. There is no meeting required to start.

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Rather see the process first? How credentialing works.

Payers control participation, timing, effective dates and reimbursement. Commercial credentialing commonly runs 60 to 120 days per payer and we do not promise a shorter answer. You complete and attest your own CAQH/DataSpring profile; we never ask for your password and we cannot attest for you.