Medicaid Exclusion List: A State-by-State Screening Guide
Healthcare compliance teams face a persistent blind spot that could lead to six-figure fines, reputational damage, and lost revenue. While most sanction screening programs focus on the OIG’s List of Excluded Individuals and Entities (LEIE) and SAM.Gov, the dozens of state-level Medicaid exclusion lists carry the same screening obligation.
Overlooking those lists, or failing to regularly screen them, has real repercussions. One New York home attendant program paid $866,339 to settle allegations that it employed an individual excluded from New York Medicaid. That person would not necessarily have appeared on a standard LEIE and SAM search.
The problem is that many organizations lack either the knowledge or resources required to reliably avoid such scenarios. California’s list alone carries more than 23,000 excluded individuals and entities, which shows how much exposure sits outside the federal databases.
What is a State Medicaid Exclusion List?
A state Medicaid exclusion list identifies healthcare providers, vendors, and individuals who are prohibited from participating in that state’s Medicaid program. These lists are separate from the federal OIG List of Excluded Individuals and Entities (LEIE), so screening the LEIE alone may not identify every excluded party.
Healthcare organizations should therefore check the federal LEIE and all applicable state Medicaid exclusion lists regularly to reduce compliance and payment risk. Yet many healthcare compliance teams overlook the true risk associated with state Medicaid exclusions.
The reach of a state action does not stop at the state line. Under Section 6501 of the Affordable Care Act, a provider terminated from one state’s Medicaid program must be terminated from every other state Medicaid program as well.
Screening only the state your organization operates in leaves a blind spot, because an individual excluded elsewhere can still be disqualified from working on your Medicaid claims. Providers need to screen against all applicable Medicaid exclusion lists, not just their own state’s, and that creates several challenges for compliance teams.
How Do State Medicaid Exclusion Lists Differ From the OIG LEIE?
The LEIE is a single federal exclusion list that updates monthly, whereas each state maintains its own Medicaid exclusion list. Rather than using a centralized search engine, compliance teams must screen each of these lists separately.
That is already a problem for an industry where workloads are high, and burnout is prevalent. But it is made worse by the level of variation between state-level lists, including:
Update Cadence
States are not required to report every exclusion to the federal database in real time, creating the potential for lag between organizations’ ability to screen lists and actual exclusions. Texas updates its list daily, while North Carolina’s list is updated just once per month.
Staying up-to-date with all state exclusion lists therefore requires a complex system where different lists are screened at different cadences. For teams that run sanction screening manually, such extra complexity can easily lead to errors and oversights.
Legal Authority
States draw their exclusion authority from their own Medicaid statutes, which is why the criteria and coverage vary from state to state. Each state defines its own reasons for exclusion, its own reinstatement path, and its own reporting rules, so an exclusion in one state does not always look like an exclusion in another.
Section 6501 of the Affordable Care Act ties the states together on the back end by requiring that a termination in one state carry over to the rest, but it does not standardize how each state builds or publishes its list. A compliance program has to account for that variation rather than assume the rules are uniform.
Data and format
State Medicaid exclusion lists vary in several ways:
- Format: Some states publish a searchable database; some provide a downloadable file; and others post a static PDF
- List Name: States don’t simply call their list “Medicaid Exclusions”; they use specific titles, from Medicheck in Pennsylvania to the Suspended and Ineligible Provider List in California
- Identifiers: Some lists carry few unique identifiers beyond a name, which raises the risk of both false positives and missed matches
Each of these makes screening all of them more complex, as compliance teams must remember and factor these differences into their workflow. The effect is both more manual effort and more opportunities for a name to slip through the cracks.
The Legal Implications: Why State Medicaid Lists Are a Serious Compliance Risk
Federal healthcare programs will not pay for any item or service furnished, ordered, or prescribed by an excluded party. This is outlined in two parts of the Social Security Act:
- Section 1128 establishes the mandatory and permissive exclusions that bar individuals and entities from federal healthcare programs
- Section 1156 sets obligations tied to quality and payment.
Importantly, the CMS has instructed states to remind providers that they must search their state exclusion list routinely whenever they search the LEIE, and to screen all employees and contractors monthly.
The obligation to check state lists is an explicit CMS expectation, not an inference. And failure to do so carries demonstrable risk for organizations.
Penalties for Employing or Contracting an Excluded Party
When an organization bills a federal healthcare program for items or services provided by an excluded party, it faces several potential repercussions:
- Financial losses: Medicaid will not reimburse items or services furnished, ordered, or prescribed by an excluded party, so those costs fall on your organization.
- Civil monetary penalties: The OIG can penalize organizations that knew, or should have known, that an individual or entity was excluded, on top of repaying what was billed.
- False Claims Act liability: Billing a federal program for an excluded party’s services can also create False Claims Act exposure, which carries treble damages and per-claim penalties separate from the OIG’s civil monetary penalties.
State-by-State Medicaid Exclusion List Reference
The full range of state Medicaid exclusion lists is extensive:
| State | Administering agency | List or portal name |
| Alabama | Alabama Medicaid Agency | Individuals Excluded from the Alabama Title XIX Program |
| Alaska | Alaska Department of Health | Medical Assistance Excluded Provider List |
| Arizona | Arizona Health Care Cost Containment System (AHCCCS) | Excluded Providers List |
| Arkansas | Arkansas Medicaid | Medicaid Excluded Provider List |
| California | Dept. of Health Care Services (DHCS) | Medi-Cal Suspended and Ineligible (S&I) Provider List |
| Colorado | Dept. of Health Care Policy and Financing | Provider Termination List |
| Connecticut | Dept. of Social Services | Administrative Actions List |
| Delaware | Delaware Medicaid | Sanctioned Providers Listing |
| District of Columbia | Office of Contracting and Procurement | Excluded Parties List |
| Florida | Agency for Health Care Administration | Medicaid Exclusion List |
| Georgia | Dept. of Community Health | OIG Exclusions List |
| Hawaii | Hawaii Medicaid | Medicaid Provider Exclusion/Reinstatement List |
| Idaho | Dept. of Health and Welfare | Medicaid Exclusion List |
| Illinois | Dept. of Healthcare and Family Services | Provider Sanctions List |
| Indiana | Family and Social Services Administration | Termination of Provider Participation in Medicaid and CHIP |
| Iowa | Dept. of Health and Human Services (Iowa Medicaid) | Excluded Individuals and Entities |
| Kansas | Dept. of Health and Environment | Terminated Provider List |
| Kentucky | Cabinet for Health and Family Services | Medicaid Excluded and Termed Provider List |
| Louisiana | Dept. of Health | State Exclusion List (Adverse Actions search) |
| Maine | Dept. of Health and Human Services, Program Integrity | Exclusion Program List |
| Maryland | Dept. of Health | Maryland Medicaid Sanctioned Provider List |
| Massachusetts | Health and Human Services (MassHealth) | List of Suspended or Excluded MassHealth Providers |
| Michigan | Dept. of Health and Human Services | List of Sanctioned Providers |
| Minnesota | Dept. of Human Services | Excluded Group Providers and Excluded Individual Providers |
| Mississippi | Division of Medicaid | Sanctioned Provider List (Provider Terminations) |
| Missouri | Dept. of Social Services | Provider Sanctions |
| Montana | Dept. of Public Health and Human Services | Excluded or Terminated Montana Medicaid Enrollment |
| Nebraska | Dept. of Health and Human Services, Division of Medicaid & Long-Term Care (Program Integrity) | Nebraska Medicaid Excluded Providers list (NMEP) |
| Nevada | Division of Health Care Financing and Policy (DHCFP) | Excluded and Sanctioned Providers |
| New Hampshire | Program Integrity Unit | Medicaid Provider Exclusion and Sanction List |
| New Jersey | Office of the State Comptroller, Medicaid Fraud Division | New Jersey Ineligible Provider List (Ineligible Provider Report) |
| New Mexico | Not applicable | No separate state list |
| New York | Office of the Medicaid Inspector General (OMIG) | Medicaid Exclusion List; Excluded Provider Check tool |
| North Carolina | Health and Human Services (Division of Health Benefits) | State Excluded Provider List |
| North Dakota | North Dakota Department of Health and Human Services | Provider Exclusion List |
| Ohio | Dept. of Medicaid (ODM) | Provider Exclusion and Suspension List |
| Oklahoma | Not applicable | No separate state list |
| Oregon | Oregon Health Authority | Sanctioned Provider List; State Medicaid Fraud Convictions |
| Pennsylvania | Dept. of Human Services | Medicheck (Precluded Providers) List |
| Rhode Island | Not applicable | No separate state list |
| South Carolina | Bureau of Internal Audit and Program Integrity | Excluded Provider List |
| South Dakota | Not applicable | No separate state list |
| Tennessee | TennCare | Terminated Providers List |
| Texas | HHSC Office of Inspector General | List of Excluded Individuals/Entities |
| Utah | Not applicable | No separate state list |
| Vermont | Dept. of Vermont Health Access | Excluded Providers List |
| Virginia | Not applicable | No separate state list |
| Washington | State Health Care Authority; Dept. of Social and Health Services | Provider Termination and Exclusion List (two separate lists: one from the Health Care Authority, one from DSHS) |
| West Virginia | West Virginia Medicaid | Sanctioned/Excluded Provider List |
| Wisconsin | Not applicable | No separate state list |
| Wyoming | Dept. of Health | Provider Exclusion List |
The Operational Bottleneck: Why Manual Screening Cannot Handle State Medicaid Lists
The list above demonstrates just how challenging manual screening becomes when you take seriously the requirement to review every state Medicaid exclusion list. Access, searchability, and update schedules vary widely from state to state; the naming alone is inconsistent.
As a result, the manual screening process balloons into a heavy workload with a lot of room for oversight and errors. Most healthcare compliance departments limit the scope of their screening, which means increased risk exposure, because the manual work is too great for already-stretched teams.
That is why so many organizations rely on Compliance Resource Center’s sanction screening software and services. We provide a comprehensive, centralized list and automated systems that enable teams to automate the process:
- Batch screening enables you to check every name within your organization across every list
- Automated verification assesses potential false negatives to reduce errors
- Comprehensive process documentation makes regulatory reporting fast and simple
Worried that state Medicaid exclusions are a compliance blind spot?
Frequently Asked Questions
The LEIE is a single federal list maintained by HHS OIG. A state Medicaid exclusion list is maintained separately by an individual state under its own authority. Many parties appear on a state list without appearing on the LEIE, so the two are not interchangeable.
Yes. CMS instructs providers to search their state exclusion list whenever they search the LEIE. Because state exclusions often do not reach the federal list, and can take months to do so, LEIE screening alone leaves a gap.
Roughly 42 to 45 states plus the District of Columbia maintain a separate list; the exact count varies by source. The count varies by source and changes as states add or restructure their lists. A small number of states publish no separate list and rely on the LEIE.
It depends on the state. Some update daily, some two or three times a month, and some monthly. Because cadences differ, a screening schedule set to one state’s rhythm can miss timely updates in another.
Federal healthcare programs will not pay for items or services furnished by an excluded party. If your organization bills for that person’s services, it faces civil monetary penalties of up to $25,595 per item or service, plus an assessment of up to three times the amount claimed, under a “knew or should have known” standard.
Most states publish the list through their Medicaid agency or Office of Inspector General, under names such as Medicheck, OMIG exclusions, or the Suspended and Ineligible Provider List. Access ranges from searchable databases to downloadable files and static PDFs.
Yes. CRC screens the OIG LEIE and all applicable state Medicaid exclusion lists in a single search on a set schedule, which removes the need to track each state portal manually.
Penalties follow the federal civil monetary penalty framework: up to $25,595 per item or service, plus an assessment of up to three times the amount claimed. States may also impose their own penalties under state law.
No. There is no complete national database that consolidates every state list with the LEIE. That is why organizations either screen each source separately or use a service that aggregates federal and state lists into one search.