Five-Step Medicaid Engagement Checklist for MedTech Startups
If Medicaid covers a meaningful share of your target patients, you can’t afford to leave it as an afterthought in your market access plan. But with 50+ distinct programs, multiple layers of decision-making, and widely different coverage rules, it helps to have a focused, repeatable process.
Here’s a five-step checklist to help you structure your Medicaid engagement strategy:
1. Map the Landscape
Identify states with the highest Medicaid penetration in your target population.
Quantify the opportunity: What percentage of total potential procedures or device use is Medicaid-covered in each state?
Flag states with coverage precedents in your therapeutic area.
2. Understand the Policy Pathway
Review each target state’s Medicaid fee schedules, benefit categories, and prior authorization requirements.
Look for any existing CPT/HCPCS codes and how they’re covered today.
Note whether coverage decisions are made centrally by the Medicaid agency or delegated to managed care organizations (MCOs).
3. Build the Right Relationships
Identify clinical and policy staff at the state Medicaid agency—often the medical director, pharmacy director, or benefits administrator.
For MCO-heavy states, compile a list of plan contacts, starting with network medical directors or value-based program leads.
Tailor your outreach to each stakeholder’s focus: public health impact for state agencies, quality metrics and cost avoidance for MCOs.
4. Align Your Evidence and Value Story
Adapt your materials to Medicaid’s priorities, which may center on access equity, cost control, and public health outcomes.
Highlight how your technology addresses specific state or MCO quality measures (e.g., reducing preventable admissions, improving maternal outcomes).
Use state-relevant data whenever possible—national averages carry less weight than localized evidence.
5. Time Your Ask Strategically
Align policy change requests with state budget cycles and legislative sessions; off-cycle asks may not be actionable.
For MCOs, coordinate discussions before contract renewal or quality metric reporting deadlines.
Keep in mind that coverage wins in Medicaid often take multiple cycles of engagement—plan for persistence, not a one-and-done meeting.
Medicaid engagement is a long game. But by being selective in your state targets, speaking the right language for each audience, and timing your efforts strategically, you can make meaningful inroads without burning resources on a scattershot approach.
Every MedTech founder faces tough questions about reimbursement, coding, and payer engagement. You don’t have to answer them alone.
