State Medicaid exclusion lists: which states keep one and how to check it every month

A state Medicaid exclusion list is the state’s own record of the people and companies it has barred from its Medicaid program. It sits beside the two federal lists, the OIG’s LEIE and SAM.gov, and it is not a copy of either. More than 40 states publish one, under names as different as Pennsylvania’s Medicheck List and Louisiana’s State Adverse Actions List. A transportation company that bills Medicaid in a state with a list should search it every month, along with the federal lists, for every owner, driver, dispatcher, and office worker.

This page is the lookup: where each state keeps its list, what each one holds, and how to work with lists that are all built differently. To record the searches, use the exclusion screening log, which already covers who belongs on the roster and what a match costs.

Why the federal lists miss state actions

The federal lists miss people a state has barred on its own. Under federal rules, each state Medicaid agency needs procedures for barring anyone the HHS Secretary could bar, on the same grounds, for a period the state picks (42 CFR 1002.210). Many states also end a provider’s enrollment for cause under their own codes, such as Colorado’s good-cause rule in 10 CCR 2505-10, section 8.076.1.7.

None of those state actions reaches the LEIE by itself. OIG may exclude someone because a state suspended, excluded, or otherwise sanctioned them for reasons bearing on competence, performance, or financial integrity, and that includes walking away from a program to avoid a sanction (42 CFR 1001.601). That power is permissive: “may”, not “must”. Until OIG acts, if it ever does, the state list is the only place the name appears.

States say so plainly. Kentucky’s page says its list holds only providers terminated or excluded from Kentucky Medicaid. Vermont’s says its list shows people excluded by its own Department of Vermont Health Access and Agency of Human Services, and may not include anyone barred by other agencies.

What CMS told states in 2008 and 2009

CMS put the monthly habit in writing in two State Medicaid Director Letters.

• SMDL #08-003, June 12, 2008. Aimed at the states’ own enrollment screening. States should search the Medicare Exclusion Database or the LEIE for every provider and every person with an ownership or control interest, meaning 5 percent or more or a managing employee. They should search monthly to catch new exclusions and reinstatements, and check out-of-state providers as well as in-state ones.
• SMDL #09-001, January 16, 2009. Pushed the duty down to providers. States should tell providers to screen all employees and contractors, make that a condition of enrollment, require a monthly LEIE search, and require providers to report any exclusion they find immediately. Its list of services Medicaid cannot pay for includes those performed by excluded ambulance drivers, dispatchers, and other transportation employees. It added that states keeping their own lists should remind providers to search the state list routinely whenever they search the LEIE.

The states’ own duty is now a regulation. Under 42 CFR 455.436, each state Medicaid agency must check the LEIE and the federal excluded parties list at least monthly for its providers, their owners, agents, and managing employees.

State wording on the provider’s side still varies. Alabama, Georgia, and Massachusetts tell providers to search monthly. Maine recommends screening “at set time intervals, i.e. annually, quarterly, etc.” Hawaii asks for its own list monthly but the LEIE only once a year. When a state asks for less than CMS’s monthly standard, monthly still satisfies both.

Each state’s exclusion list

At least 42 states publish a list of their own. The table names each list, links to the page where it lives, and notes how it is kept or what it covers. Lists come and go from these pages, so open the link each month instead of reusing a saved file.

States that point you to the federal list instead

A few states publish no separate exclusion list, and their own pages send providers to the LEIE.

• South Dakota. The state Medicaid FAQ answers “Where do I find an excluded provider list?” by pointing to the HHS OIG exclusions database.
• Indiana. FSSA posts providers terminated for cause, but says that list “is not an active or ongoing exclusionary list” and is for information only. Read it anyway when hiring someone who held an Indiana Medicaid enrollment.
• Rhode Island. A November 2020 letter from the Executive Office of Health and Human Services tells providers to screen before hiring, search the LEIE monthly, search the federal excluded parties list, and report any exclusion to the state at once. It names no state list.

If your state is not in the table, ask its Medicaid program integrity office which lists it expects you to search, and keep the reply in writing. That answer is what a broker or state auditor will hold you to.

A termination in one state reaches the others

A provider that one state terminates for cause must be kept out by every other state for at least as long as the federal termination database carries it: the original state’s term or 10 years, whichever is shorter. The duty comes from Social Security Act section 1902(a)(39), as amended by section 6501 of the Affordable Care Act, and reaches terminations from January 1, 2011 on (42 CFR 455.416(c), 455.417). Appeals and reenrollment bars are in the guide to Medicaid provider termination.

The duty falls on state agencies. It does not add the terminated provider’s name to your own state’s list, so the other state’s list is where a small transportation company will see it.

Drivers who lived or worked in another state

Check the list of each state where a new hire has lived or worked in health care, not only the states you bill. The federal lists catch a state action only after OIG decides to act on it, and the state lists hold only their own state’s actions, so a driver barred in one state can come up clean everywhere else.

States also treat each other’s actions as grounds. MassHealth, for one, names suspension or exclusion by any other state’s Medicaid agency as a ground for suspending or excluding a provider itself.

Take an example. A company billing Kansas Medicaid hires a dispatcher who once owned a transportation company enrolled with Missouri Medicaid. A clean result on the LEIE, SAM, and the Kansas list says nothing about the Missouri years. Add the Missouri MMAC sanctions list to that dispatcher’s first check, and keep both results in the personnel file next to the background check.

Nevada’s Medicaid inspector general maintains a page of links to other states’ lists, which saves time when a new hire’s history crosses several states. Treat it as a starting point and confirm each link against the table above.

Searching lists that all work differently

No two state lists work the same way, so set up each one once and write down how you search it.

1. Use the format the state offers. New York’s online search takes five names at once and offers a separate short list of exclusions from the last 30 days. Louisiana and Maine search by name, then let you check a possible match against a Social Security number. Most other states post a spreadsheet or PDF.
2. Pull a fresh file each month. Ohio tells providers to use the file on its page instead of a copy stored on their computer. Pennsylvania updates Medicheck daily, and Arkansas warns its results can change daily.
3. Search every name a person has used. Iowa tells providers to search all known names because people are often excluded under another one.
4. Match on more than the name. Ohio lists birth dates and last known addresses, Michigan lists NPI and license numbers, and Delaware’s report lists NPI, taxonomy, and license numbers. North Dakota confirms qualified service providers, who have no NPI, by name, date of birth, and the final four SSN digits.
5. Report what you find on the state’s terms. Georgia wants any exclusion among staff reported to its provider enrollment section immediately. Texas asks to be notified, and Alaska tells providers to contact Program Integrity right away.

A list that looks old is still worth the search. Alaska’s posted copy is headed January 2025, and it is still the file the state’s link opens.

Keeping the monthly check on the calendar

In HealthRide, the state list check can sit in the fleet and credentials registry as a driver credential that expires every month. A reminder goes out before it lapses, and a lapsed check shows as a warning when someone assigns that driver a trip. The searches themselves happen on the state sites, and the results belong in your exclusion screening log.