Unlocking State Medicaid for Medtech

For many MedTech companies, U.S. reimbursement strategy usually starts with two big pillars: Medicare and commercial payers. Those are the familiar arenas, with defined coding processes, published coverage policies, and recognizable decision-makers.

Then there’s Medicaid.
And that’s where the playbook can start to feel a little less familiar.

Medicaid is not one program. It’s 50 state-run programs, plus territories and the District of Columbia, each with its own rules, processes, and political landscape. The variability can make Medicaid engagement feel unpredictable, especially for teams accustomed to the structure of Medicare or the deal-making mindset of commercial insurers. But ignoring Medicaid is rarely an option, particularly if your technology serves populations where it plays a meaningful role.

Medicaid’s importance to MedTech depends on your tech’s market segment. In some therapeutic areas, it is the primary payer—pediatrics, certain women’s health interventions, and many services for people with disabilities or chronic conditions. In some states, enrollment exceeds 30% of the total population, so payer mix alone can make it a significant factor in your access strategy. Even for Medicare-heavy technologies, Medicaid may still matter in cases of “dual eligibles” (patients covered by both Medicare and Medicaid) because Medicaid often picks up cost-sharing after Medicare has paid, which can influence both patient affordability and provider willingness to adopt new products.

For companies used to Medicare’s national and local coverage determinations or commercial payers’ published policies, Medicaid can feel opaque. Every state has its own benefit structure, coverage determination process, and documentation requirements. Many existing policies were written for older, legacy technologies and don’t cleanly accommodate new innovations. In addition, within a single state, you may need to work with both the Medicaid agency and the managed care organizations contracted to deliver benefits, each of which has its own set of decision-makers.

Succeeding with Medicaid requires rethinking the engagement approach. Instead of relying on a single national strategy, companies must evaluate each state individually, beginning with a mapping exercise to identify where Medicaid is most relevant to their target population and where coverage pathways are more navigable. Early conversations with clinical leaders and policy staff at the state level are important to understand not just the formal policy, but also the practical considerations that drive coverage decisions. Evidence requirements may differ from those in Medicare or commercial markets—sometimes they are more flexible, sometimes more stringent, and often shaped by budget constraints or legislative priorities.

The presence of managed care adds another layer. In most states, Medicaid benefits are delivered through private managed care plans. While these plans operate under contracts with the state, they often have latitude in how they interpret and operationalize coverage. This means a MedTech company may need to make its case twice: once to the state agency and again to each contracted plan. The upside is that managed care plans can sometimes move faster than the state itself, particularly when a technology supports their quality measures, reduces high-cost events, or helps them meet performance goals outlined in their state contracts.

The first step for any MedTech company is to size up the opportunity. If Medicaid accounts for a small fraction of your addressable market, engagement may be a later-phase priority. But if a large share of your target patients is covered by Medicaid, it should be integrated into your market access plan from the outset, with the understanding that the tactics will look and feel different from Medicare or private payer work. Unlocking Medicaid isn’t about reusing your Medicare pitch—it’s about understanding state-specific priorities, building relationships with the right mix of stakeholders, and shaping your value story around the program’s goals, whether that’s budget stewardship, access equity, or meeting legislatively mandated coverage requirements.

Medicaid isn’t one system—and your access strategy shouldn’t be either.

If your technology touches Medicaid-covered populations, let’s map out the right state-by-state approach. Coustier Advisory can help you identify the right decision-makers, align your value story with local priorities, and avoid costly delays in coverage.

Schedule a 30-minute consult to explore how your current study plan stacks up — and what evidence you may need to unlock broader coverage.

Learn more about Coustier Advisory.