What is a Medicaid exclusion list?

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A Medicaid exclusion list is an official registry of healthcare providers, individuals, and entities barred from participating in or receiving reimbursement from government-funded healthcare programs like Medicaid and Medicare.

đź“Ś Key Facts About Exclusion Lists

  • Purpose: Block federal and state funds from going to fraudulent or untrustworthy providers.
  • Prohibition: Excluded parties cannot bill, order, prescribe, or furnish services to program beneficiaries.
  • Management: Maintained at both the federal level (like the HHS-OIG LEIE) and individual state levels.
  • Scope: An exclusion in one state or federal program typically applies nationwide across all government health programs.
  • Consequences: Healthcare organizations face severe civil monetary penalties or legal liability for hiring or billing services through listed individuals.

⚠️ Common Reasons for Inclusion

  • Fraud: Convictions for Medicare or Medicaid fraud.
  • Patient Abuse: Criminal findings of patient abuse or neglect.
  • Licensing Issues: Revocation, suspension, or surrender of a professional healthcare license.
  • Controlled Substances: Felony convictions related to unlawful manufacture, distribution, or dispensing of controlled substances.

What does an exclusion list mean?

An exclusion list is a record of people, businesses, or items that are barred from a program, or a set of rules used to ignore specific benign data. The meaning depends entirely on the context—most commonly appearing in healthcare compliance or IT security.

Healthcare and Government Programs

In government and healthcare, an exclusion list is an official database of individuals or organizations banned from participating in federally funded programs like Medicare or Medicaid.

  • The Goal: To protect patients and stop fraud, waste, or abuse.
  • The Rule: Federal programs cannot pay for any services, prescriptions, or items provided by anyone on these lists.
  • Main Examples: The HHS-OIG Exclusions Program maintains the List of Excluded Individuals/Entities (LEIE), and the federal government uses SAM.gov for broader non-healthcare federal program exclusions.
  • The Penalty: Companies that hire or contract with anyone on an exclusion list face severe civil fines and legal penalties.

Technology and Security

In software, spam filters, and cybersecurity, an exclusion list (often called an allowlist or exception list) is the exact opposite of a detection rule.

  • The Goal: To reduce false alarms and cut down on wasted investigations.
  • The Rule: It tells a security tool or filter which specific patterns, files, or sender addresses to ignore because they are known to be safe.
  • Common Examples: Trusted internal email domains bypassed by a spam filter, or approved safe file paths ignored by an antivirus scanner.

How can I find the Kentucky Medicaid exclusion list?

The Kentucky Department for Medicaid Services maintains the official Terminated and Excluded Provider List to bar disqualified individuals and entities from receiving state Medicaid reimbursement.

Overview of the List

  • Purpose: Any service ordered, referred, or rendered by an excluded party is non-payable, and employing them risks financial recoupment.
  • Format & Access: Published as a downloadable document on the Kentucky Medicaid Termination and Exclusion List.
  • Data Included: Provider names, National Provider Identifiers (NPI), license numbers, effective dates, and reasons for action (such as policy violations or license revocations).

Compliance and Screening Rules

  • Frequency: Participating providers and applicants must perform pre-hire and monthly searches of both the state exclusion list and the federal System for Award Management (SAM).
  • Federal Cross-Checks: HHS/OIG-excluded entities are automatically barred from Kentucky Medicaid even if they do not explicitly appear on the state-specific roster.
  • Re-enrollment: Terminated providers may apply for reinstatement only by meeting specific state administrative regulations (907 KAR 1:671 and 1:672).

Who is on the NC Medicaid exclusion list?

You can view and search the official NC Medicaid Excluded Providers List directly on the North Carolina Department of Health and Human Services website.

Key Details About the List

  • Purpose: It bars terminated or sanctioned individuals and legal entities from billing or receiving reimbursement from federal or state healthcare programs.
  • Update Frequency: The state updates the provider termination and exclusion list monthly.
  • Duration: An exclusion remains in effect until the provider's name is officially removed from the list.
  • Impact: Services ordered, referred, or rendered by excluded parties are non-payable.

Where can I find the Alaska Medicaid exclusion list?

The Alaska Department of Health maintains the Alaska Medical Assistance Excluded Provider List to track individuals and entities terminated from the Medicaid program.

Overview of the Exclusion List

  • Purpose: Identifies providers whose agreements were terminated due to fraud, OIG mandatory exclusions, or other sanctions.
  • Scope: Excluded providers are prohibited from participating or providing services in Medicaid across all categories of care, regardless of who submits the claims.
  • Access: The state publishes periodic updates via the Alaska Department of Health Program Integrity page and accessible PDF documents like the Alaska Medical Assistance Exclusion List.

Compliance and Checking Requirements

  • Screening: Healthcare employers must check both the state exclusion list and federal databases—such as the OIG List of Excluded Individuals/Entities (LEIE) and SAM.gov—prior to hiring and on a regular monthly basis.
  • Reporting: Finding an active employee or contractor on the exclusion list requires immediate contact with the Alaska Medicaid Program Integrity Unit via email at QAPIProgramIntegrity@alaska.gov.
  • Reinstatement: Excluded providers seeking to rejoin after their penalty period must submit a formal reinstatement application directly through the state Program Integrity division.

What is the Medi-Cal Exclusion List and How to Get Off of it

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How to get off Medicaid exclusion list?

To get off a federal or state Medicaid exclusion list, you must formally apply for reinstatement once your mandatory or permissive exclusion period ends, as removal is not automatic.

1. Check Your Eligibility Timing

  • Federal LEIE (OIG): You can submit your written reinstatement request starting 90 days before your defined exclusion period ends. Sending an application early will result in it being ignored.
  • State Medicaid Lists: State-specific exclusions operate independently from the federal Office of Inspector General (OIG). You must clear both the federal Office of Inspector General Reinstatements and your specific state's Medicaid agency exclusion list (such as Ohio Medicaid Provider Exclusion or your local state equivalent).

2. Prepare the Application Package

  • Written Request: Include your full name, aliases, date of birth, phone number, email address, and mailing address.
  • Supporting Documentation: Provide proof that your exclusion term is complete, any underlying professional licenses have been reinstated or resolved, and any required notarized statement or authorization forms are completed.
  • Submission: Submit your request to the federal level via email at reinstatements@oig.hhs.gov or mail it to the HHS OIG Exclusions Branch in Washington, DC. Submit separate paperwork to your state Medicaid office if you were suspended at the state level.

3. Await Review

  • The review process takes 120 days or longer.
  • If approved, you will receive written confirmation, and your name will be removed from the database.
  • If denied, you typically must wait one full year before you can reapply.

How can I find a Medicaid exclusion list in Florida?

The Florida Medicaid exclusion list (Medicaid Sanctioned Providers) is managed by the Florida Agency for Health Care Administration (AHCA).

Overview of Florida Exclusions

  • Managing Agency: The AHCA's Bureau of Medicaid Program Integrity (MPI) handles terminations, suspensions, and sanctions for providers.
  • Purpose: Prevents terminated or suspended medical providers, individuals, and entities from receiving state Medicaid funds due to fraud, abuse, or criminal offenses.
  • Search Tool: You can search official state legal orders and sanctioned provider categories directly through the AHCA Documents Search Portal by selecting "Medicaid Sanctioned Providers" under the search criteria.

Compliance Requirements

What is a Medicaid exclusion check?

A Medicaid exclusion check is the process of verifying that an employee, provider, vendor, or contractor is not barred from participating in government healthcare programs.

Why It Is Done

  • Prevents Fraud: It ensures healthcare organizations do not hire or contract with individuals banned for misconduct, fraud, or patient abuse.
  • Avoids Penalties: Organizations that submit claims or receive federal reimbursement tied to an excluded person face steep financial penalties.
  • Protects Funding: It keeps organizations compliant with rules set for programs like Medicaid and Medicare.

How Checks Work

  • Databases Searched: Organizations check federal lists like the Office of Inspector General LEIE and SAM.gov, alongside state-specific Medicaid exclusion lists.
  • Frequency: Best practices and state guidelines typically require running these checks before hiring and on a monthly basis thereafter.

How much money can you make and still get Medicaid in KY?

The amount of money you can make and still qualify for Kentucky Medicaid depends entirely on your household size and which eligibility group you fall into.

For adults aged 19–64, the income limit is 138% of the Federal Poverty Level (FPL). Under the 2026 guidelines, this equals an annual income of $22,025 for a single person or $45,540 for a family of four.

The strict monthly income thresholds for different household sizes and categories are broken down below:

1. General Adults & Caretakers (Ages 19–64)

This category includes adults without children as well as parents/caretaker relatives. There are no asset limits for this track.

  • Household of 1: $1,835 per month
  • Household of 2: $2,490 per month
  • Household of 3: $3,144 per month
  • Household of 4: $3,799 per month

2. Pregnant Individuals

Pregnant women qualify under higher income limits (200% FPL), and the unborn baby counts as part of the household size. Coverage continues for 12 months postpartum.

  • Household of 2 (Pregnant individual + unborn baby): $3,606 per month
  • Household of 3: $4,554 per month
  • Household of 4: $5,500 per month

3. Children (Medicaid & KCHIP)

Kentucky provides coverage for children through regular Medicaid or the Kentucky Children’s Health Insurance Program (KCHIP) at expanded limits:

  • Children under age 1: Up to 200% FPL.
  • Children ages 1 to 18: Up to 147% FPL for standard Medicaid, and up to 218% FPL through KCHIP. For a family of four, 218% FPL is $5,994 per month ($71,940/year).

4. Seniors (Ages 65+) and Individuals with Disabilities (ABD)

For those qualifying based on age or a permanent disability, the regular ABD Medicaid income limit is capped at $994 per month for a single applicant. However, there are two alternate routes if you make more:

  • Nursing Home & HCB Waivers: If you require long-term care or home-based assistance waivers, the maximum income limit rises to $2,982 per month. (Note: Asset limits of $2,000 for an individual apply here).
  • Medically Needy Spend-Down: If your income exceeds the standard limits, Kentucky allows a "spend-down" program where you can still qualify after deducting your out-of-pocket medical expenses from your countable income.

You can screen your exact eligibility parameters or submit an application online via the kynect Benefits Portal or by calling the Kentucky health benefit exchange at 1-855-459-6328.

How do you get excluded from Medicaid?

You get excluded from participating as a Medicaid provider or receiving federal healthcare payments due to fraud, patient abuse, or criminal convictions.

(Note: If you meant losing personal health coverage eligibility rather than being barred as a healthcare provider or worker, disqualification typically happens when income or assets exceed state limits.)

Mandatory Reasons for Exclusion

The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) and state agencies must bar individuals and entities for specific serious offenses:

  • Healthcare fraud: Convictions for fraud related to Medicare, Medicaid, or other federal programs.
  • Patient abuse or neglect: Criminal acts harming patients in connection with the delivery of a healthcare item or service.
  • Felonies: Convictions for financial crimes or controlled substances linked to the healthcare sector.
  • Minimum terms: Mandatory exclusions carry a strict minimum 5-year ban for first offenses, 10-year bans for second offenses, and permanent bans for third offenses.

Permissive Reasons for Exclusion

Authorities also hold the power to exclude providers under discretionary or permissive grounds:

  • Licensure revocation: Losing a professional medical license due to poor quality of care, professional incompetence, or disciplinary action.
  • Misdemeanor convictions: Fraud or obstruction related to any federal, state, or local healthcare program.
  • Substandard care: Supplying dangerous, inadequate, or low-quality services to patients.
  • Default on health education loans: Failing to repay government-backed student loans or scholarship obligations for health professionals.

Consequences and Checks

  • No federal funds: Excluded parties cannot receive payment for any items or services furnished, ordered, or prescribed under Medicaid.
  • Employment ban: Healthcare entities face heavy civil monetary penalties if they hire or contract with anyone on the exclusion list.
  • Screening databases: States routinely check the federal List of Excluded Individuals/Entities (LEIE) alongside state-specific databases to catch and remove sanctioned providers.