California · Medicaid: Medi-Cal
Medi-Cal claims run through a separate submission path from commercial payers, and the timely filing window is shorter than most practices assume.
What changes from state to state
The work is the same everywhere. What changes is the Medicaid programme, the timely filing window, the prevailing wage mechanism and the portal. Each page below carries the fact that is true of that state and not of the others.
Texas · Medicaid: Texas Medicaid
Texas Medicaid runs through TMHP with its own enrollment and its own claim submission rules, separate from commercial payers.
Florida · Medicaid: Florida Medicaid
Florida Medicaid is delivered largely through managed care plans, so a single practice may be dealing with six or seven separate payer portals.
New York · Medicaid: NY Medicaid
New York Medicaid and the managed care plans layered over it each carry different prior authorization rules.
Washington · Medicaid: Apple Health
Apple Health is administered through managed care organizations, each with its own authorization pathway.
Illinois · Medicaid: Illinois Medicaid
Illinois Medicaid managed care consolidated into a smaller number of plans, each with distinct credentialing timelines.
New Jersey · Medicaid: NJ FamilyCare
NJ FamilyCare runs through managed care organizations with their own enrollment queues.
Pennsylvania · Medicaid: PA Medical Assistance
Pennsylvania Medical Assistance operates alongside HealthChoices managed care plans.
Ohio · Medicaid: Ohio Medicaid
Ohio Medicaid moved to a Next Generation managed care structure with a single front door but multiple plans behind it.
Georgia · Medicaid: Georgia Medicaid
Georgia Medicaid runs through Care Management Organizations, each with its own credentialing process.
Alabama · Medicaid: Alabama Medicaid
Alabama has not expanded Medicaid and its programme stays largely fee-for-service, with care coordination through the Alabama Coordinated Health Network rather than full-risk managed care plans.
Alaska · Medicaid: Alaska Medicaid
Alaska pays Medicaid on a fee-for-service basis rather than contracting with managed care organizations, and a large share of care runs through the tribal health system under Indian Health Service billing rules.
Arizona · Medicaid: AHCCCS (Arizona Health Care Cost Containment System)
Arizona delivers AHCCCS almost entirely through contracted health plans, with AHCCCS Complete Care covering acute and behavioral needs and separate programmes for long-term care, so claims usually go to a plan.
Arkansas · Medicaid: Arkansas Medicaid
Arkansas covers much of its expansion population through ARHOME, which buys qualified health plan coverage from commercial carriers, so those members carry a commercial plan card alongside their Medicaid eligibility.
Colorado · Medicaid: Health First Colorado
Health First Colorado runs through the Accountable Care Collaborative, where Regional Accountable Entities coordinate care and hold the behavioral health benefit while most physical health claims are still paid fee-for-service by the state.
Connecticut · Medicaid: HUSKY Health
Connecticut moved HUSKY Health off risk-bearing managed care in 2012 and now self-insures the programme, paying claims fee-for-service through administrative services organizations rather than through contracted managed care plans.
Delaware · Medicaid: Delaware Medicaid (Diamond State Health Plan)
Delaware runs nearly all of its Medicaid through the Diamond State Health Plan managed care waiver, and because the state is small a practice deals with only a handful of plans statewide.
Hawaii · Medicaid: Med-QUEST (QUEST Integration)
Hawaii delivers almost all Medicaid through QUEST Integration health plans, and the commercial market is concentrated partly because the 1974 Prepaid Health Care Act obliges employers to cover staff working at least twenty hours weekly.
Idaho · Medicaid: Idaho Medicaid
Idaho expanded Medicaid by voter initiative, ran the programme largely fee-for-service for years, and is now moving toward statewide managed care, with behavioral health already under a single statewide contract.
Indiana · Medicaid: Indiana Medicaid (Indiana Health Coverage Programs)
Most Indiana Medicaid members sit with managed care entities across Hoosier Healthwise, Hoosier Care Connect, the Healthy Indiana Plan and PathWays for Aging, so billing staff work several plan contracts.
Iowa · Medicaid: Iowa Medicaid (IA Health Link)
Nearly all Iowa Medicaid members are enrolled with a small number of managed care organizations under IA Health Link, and Wellmark Blue Cross Blue Shield is the dominant commercial carrier statewide.
Kansas · Medicaid: KanCare
Kansas runs almost all of its Medicaid through KanCare managed care plans and has not adopted ACA expansion, so eligibility screening and the self-pay mix weigh more heavily than in expansion states.
Kentucky · Medicaid: Kentucky Medicaid
Kentucky expanded Medicaid early and enrols most members with a small set of managed care organizations, while Medicare Advantage enrollment runs high statewide and Humana is headquartered in Louisville.
Louisiana · Medicaid: Louisiana Medicaid (Healthy Louisiana)
Louisiana expanded Medicaid in 2016 and delivers most of the programme through Healthy Louisiana managed care plans, while Blue Cross and Blue Shield of Louisiana remains the dominant commercial carrier.
Maine · Medicaid: MaineCare
MaineCare is one of the few Medicaid programmes still run mainly fee-for-service rather than through comprehensive risk-based managed care, and Maine's older population gives most practices a high Medicare share.
Maryland · Medicaid: Maryland Medicaid (HealthChoice)
Maryland is the only state with all-payer hospital rate setting: a state commission sets hospital rates for every payer under a federal Medicare waiver instead of each plan negotiating separately.
Massachusetts · Medicaid: MassHealth
Most MassHealth members receive care through Accountable Care Organizations or managed care plans rather than straight fee-for-service, and the commercial market is concentrated among regional insurers led by Blue Cross Blue Shield of Massachusetts.
Michigan · Medicaid: Michigan Medicaid
Most Michigan Medicaid beneficiaries, including the Healthy Michigan Plan expansion group, are enrolled in contracted managed care health plans, and Blue Cross Blue Shield of Michigan remains the dominant commercial payer statewide.
Minnesota · Medicaid: Medical Assistance (Minnesota Medicaid)
Minnesota delivers most Medical Assistance through prepaid managed care contracts, and its commercial and Medicare Advantage markets remain concentrated among regional nonprofit health plans rather than the large national carriers.
Mississippi · Medicaid: Mississippi Medicaid
Most Mississippi Medicaid beneficiaries are enrolled in MississippiCAN managed care plans, so plan-by-plan credentialing gates payment for a provider base that is heavily rural and weighted towards small independent practices.
Missouri · Medicaid: MO HealthNet
MO HealthNet contracts with managed care plans statewide for most children, pregnant women and the adults added when expansion took effect in 2021, while aged, blind and disabled members largely stay fee-for-service.
Montana · Medicaid: Montana Medicaid
Montana Medicaid is still delivered largely fee-for-service rather than through risk-bearing managed care organizations, and much of the state's provider base sits in rural critical access hospitals and small independent clinics.
Nebraska · Medicaid: Nebraska Medicaid
Nebraska Medicaid runs through the Heritage Health programme, which combines physical health, behavioral health and pharmacy benefits under a small number of contracted plans, so enrollment with each plan governs whether claims pay.
Nevada · Medicaid: Nevada Medicaid
Nevada Medicaid moved to statewide managed care in January 2026, extending contracted plans into rural and frontier counties that were previously fee-for-service, so plan enrollment now drives payment almost everywhere.
New Hampshire · Medicaid: New Hampshire Medicaid
New Hampshire Medicaid delivers most benefits through its Medicaid Care Management programme, so the majority of claims go to contracted managed care plans rather than to state fee-for-service.
New Mexico · Medicaid: New Mexico Medicaid (Turquoise Care)
New Mexico is a mostly rural state where a high share of residents are covered by Medicaid, most of it delivered through contracted managed care plans rather than fee-for-service.
North Carolina · Medicaid: North Carolina Medicaid
North Carolina moved most Medicaid members into managed care plans while keeping NC Medicaid Direct for certain populations, and Blue Cross NC remains the largest commercial payer statewide.
North Dakota · Medicaid: North Dakota Medicaid
North Dakota still pays much of its traditional Medicaid on a fee-for-service basis, and Blue Cross Blue Shield of North Dakota holds a large share of the commercial market.
Oklahoma · Medicaid: SoonerCare
SoonerCare is administered by the Oklahoma Health Care Authority, which ran a largely fee-for-service model before moving a large share of members into SoonerSelect managed care plans.
Oregon · Medicaid: Oregon Health Plan
The Oregon Health Plan delivers most Medicaid benefits through regional Coordinated Care Organizations working under global budgets, so claims usually go to a CCO rather than direct to the state.
Rhode Island · Medicaid: Rhode Island Medicaid
Most Rhode Island Medicaid members receive benefits through managed care plans under the RIte Care umbrella, and the state's small commercial market is concentrated among a handful of insurers.
South Carolina · Medicaid: Healthy Connections Medicaid
South Carolina's Healthy Connections Medicaid runs mainly through contracted managed care plans, and BlueCross BlueShield of South Carolina's Palmetto GBA subsidiary serves as a Medicare Administrative Contractor.
South Dakota · Medicaid: South Dakota Medicaid
South Dakota Medicaid is delivered largely fee-for-service rather than through commercial managed care organizations, and much of the commercial market sits with provider-owned plans tied to the Sanford and Avera health systems.
Tennessee · Medicaid: TennCare
TennCare enrols nearly its whole Medicaid population in managed care organizations, so eligibility, prior authorization and claims run through the member's health plan rather than a state fee-for-service desk.
Utah · Medicaid: Utah Medicaid
Utah Medicaid contracts with accountable care organizations along the Wasatch Front while many rural counties remain fee-for-service, and the commercial side is led by the Intermountain-affiliated SelectHealth plan.
Vermont · Medicaid: Vermont Medicaid (Green Mountain Care)
Vermont contracts with no commercial Medicaid managed care organizations and administers the programme itself, and its small commercial market is concentrated in a few carriers led by Blue Cross Blue Shield of Vermont.
Virginia · Medicaid: Cardinal Care (Virginia Medicaid)
Cardinal Care moved most Virginia Medicaid members into managed care plans, while practices in northern and coastal Virginia also carry heavy TRICARE and federal employee health benefit volume.
West Virginia · Medicaid: West Virginia Medicaid
Much of West Virginia's claim volume sits with public payers: Medicaid through the Mountain Health Trust managed care plans, a high Medicare and disability share, and PEIA for public employees.
Wisconsin · Medicaid: BadgerCare Plus (Wisconsin Medicaid)
BadgerCare Plus enrols most members through contracted HMOs, and Wisconsin's commercial market is unusually fragmented, with several provider-sponsored regional plans rather than one carrier holding the bulk of the business.
Wyoming · Medicaid: Wyoming Medicaid
Wyoming runs Medicaid mainly on a fee-for-service basis rather than through managed care organizations, has not adopted expansion, and its small commercial market is led by Blue Cross Blue Shield of Wyoming.
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