State Medicaid Exclusion Lists: Why the Federal Lists Are Not Enough

Your compliance team checks every employee against the OIG exclusion list each month. A new hire comes back with no possible match, starts work, and six months later you learn that the state Medicaid agency terminated them from the program two years ago. The federal list never showed it, because the federal list was never going to.

That gap is what state Medicaid exclusion lists are for. This post explains why they exist, how they differ from the OIG and SAM.gov lists, which state list pages we verified, and how to fold the right states into a screening program. For the federal side, our free exclusion check searches the OIG LEIE, SAM.gov exclusions and the OFAC SDN list for up to 25 names at once.

What a state Medicaid exclusion list is

Each state runs its own Medicaid program, jointly funded with the federal government. Each state can also exclude, terminate or suspend providers from that program. Many states publish the result as a list, usually maintained by the state Medicaid agency or a state Medicaid inspector general.

The names vary. Some states call it an exclusion list, some a termination list, some a sanctions list, and Pennsylvania calls its list the Medicheck List. What they have in common is that they name parties the state will not pay through its Medicaid program, or that the state has removed from it.

Why the federal lists are not enough

The OIG exclusion list covers parties excluded by HHS-OIG from all federal health care programs. A state action does not automatically produce an OIG exclusion. A state can terminate a provider's Medicaid enrollment for its own reasons, such as a state audit finding, a licensing action or a failure to meet enrollment requirements, and that termination may never reach the LEIE.

SAM.gov does not fill the gap either. It holds federal agency exclusions related to federal contracts and assistance, not state Medicaid actions.

So an organization that bills Medicaid and screens only the federal lists can employ or contract with someone the state has already removed from its program. The payment problem is the same in kind: the state Medicaid program will not pay for services tied to a party it has excluded.

One state's action can follow a provider to others

Federal rules link the states together. Under 42 CFR 455.416, a state Medicaid agency must deny enrollment to, or terminate, a provider that has been terminated for cause by Medicare or by another state's Medicaid program or CHIP. State Medicaid agencies also have to check providers against federal databases under 42 CFR 455.436.

For a provider group, the practical effect is that an employee or contractor terminated in one state can be a problem in another. If you hire clinicians who have worked in other states, the states on their work history matter, not only the state you are in.

State list pages we verified

The table below is partial. It lists state Medicaid exclusion and termination list pages that we checked by hand on 2026-10-18 and that loaded at the address shown. Many other states publish lists too; we left out any page we could not load and verify that day. State agencies move these pages from time to time, so check the address before you build it into a procedure.

State	List	Published by	Checked
Georgia	Georgia OIG Exclusions List	Department of Community Health	2026-10-18
Illinois	Provider Sanctions	Healthcare and Family Services, Office of Inspector General	2026-10-18
Iowa	Excluded Individuals and Entities	Iowa Health and Human Services	2026-10-18
Montana	Excluded or Terminated Montana Medicaid Providers	Department of Public Health and Human Services	2026-10-18
Nevada	Provider Exclusions, Sanctions and Press Releases	Office of the Medicaid Inspector General	2026-10-18
New York	Medicaid Exclusions	Office of the Medicaid Inspector General	2026-10-18
North Carolina	Excluded Providers	NC Medicaid, Department of Health and Human Services	2026-10-18
Pennsylvania	Medicheck List	Department of Human Services	2026-10-18
Vermont	Medicaid Excluded Providers	Department of Vermont Health Access	2026-10-18
Washington	Provider termination and exclusion list	Health Care Authority	2026-10-18

If your state is not in the table, start from your state Medicaid agency's provider pages or its program integrity or inspector general office, and look for an exclusion, termination or sanctions list.

How state lists differ from each other

Expect variation in four places:

• Format. Some states offer a searchable web page. Others publish a spreadsheet or a PDF that you download and search yourself.
• Fields. Some lists carry an NPI or a Medicaid provider number; others carry little more than a name, a city and a date. Fewer identifiers means more possible matches to confirm.
• Scope. Some lists include only exclusions. Others include terminations, suspensions or reinstatements, and some cover individuals and entities on separate pages.
• Schedule. States update their lists on their own schedules, and not every state says when the file last changed. Record the date you checked and, where the state shows one, the date of the file.

Adding state lists to a screening program

A workable approach looks like this:

• Pick the states. Start with every state where you are enrolled in Medicaid or deliver services. Add the states in the work history of clinicians and contractors you hire, because of the for-cause termination rule above.
• Read your provider agreement. Your state Medicaid provider agreement or manual may say which lists to check and how often. Follow the state's rule where it is more specific than your default.
• Screen at hire, then on a schedule. Run the state checks at onboarding with the federal checks, then rescreen on the same cycle. Monthly is the common standard for the federal lists, and many organizations use the same cycle for the state lists.
• Confirm every possible match with the state. Compare the identifiers the list holds, and contact the state agency if the list does not give you enough to decide.
• Record each check. Keep the date, the state, the list, the file date where shown, the names checked and the outcome, including how each possible match was confirmed or ruled out.

Automating it

State lists are where screening gets harder to automate. Every state is its own source with its own format, and sources move. A spreadsheet link that worked last month can break without notice, and a screening job that silently fails is worse than one that never ran.

That is the same problem we solved at a larger scale in our provider credentialing verification platform, which checks state licensing boards, certification boards, OIG, OFAC and SAM sanctions lists, DEA registries and payer portals at the source. It runs about 30,000 verifications a day across 641 source configurations, one per source, saves proof for every check, and flags a source when it changes so a person can approve the fix.

Start with the federal lists

The federal lists are the base of any screening program. Run your names through our free exclusion check for the OIG LEIE, SAM.gov exclusions and the OFAC SDN list, or use the OIG exclusion list search for OIG alone. Then add the state lists from the table, or your own state's list, for the states where you operate. For more on the federal side, see How often should you check the OIG exclusion list? and OIG LEIE vs SAM.gov exclusions.

Talk to us

If you need state lists checked alongside the federal ones, on a schedule, with every match and confirmation recorded, we can build that into your credentialing or HR workflow. Contact us and tell us which states you operate in.