Medicaid exclusion screening requirements in Washington
What Washington Medicaid requires of the organizations that take part in it: whether the state keeps its own exclusion list, how often it expects you to check, what the penalties are, and how an action taken in another state reaches you here. Every claim on this page links to the source it came from.
What Exclia screens for this state
Washington’s own Medicaid exclusion list is rolling out to Exclia. The federal lists (OIG LEIE and SAM.gov) are screened today.
What the state requires
Verify Apple Health participation and distinguish the HCA and DSHS publications.
HCA states that nonenrolled providers, including providers terminated for any reason, cannot provide services to Medicaid recipients. It cites enrollment requirements for professionals who prescribe, order or refer services. The page does not prescribe a universal monthly screening interval. Confirm potential matches and present enrollment with HCA; a check of its workbook does not establish DSHS or federal source coverage.
- HCA provider-list scope and enrollment requirements
- Washington DSHS social services original workbook
Why monthly, and where the exposure comes from
The HHS Office of Inspector General publishes the federal exclusion list (the LEIE) monthly, and its guidance to providers is that screening staff and contractors each month is what best limits the risk of overpayment and civil monetary penalty liability. State Medicaid agencies are themselves required to check the LEIE no less frequently than monthly (42 C.F.R. § 455.436(c)(2)), which is the rhythm the lists move on.
The state’s own list
HCA Medicaid Providers Termination and Exclusion List
Washington keeps its own Medicaid exclusion list, separate from the federal OIG list. Searching one does not cover the other.
HCA publishes its Medicaid provider workbook separately from the DSHS social services workbook. The page describes participation actions for cause and federal program restrictions; terminations without cause are omitted. Names, license references, NPI or ProviderOne references, action dates and labels are preserved as published evidence.
- Published by
- Washington State Health Care Authority
- Refreshed
- Publisher lists an update date but does not state a fixed interval., per the publishing agency.
How Exclia reads this list
Exclia reads the Health Care Authority provider termination and exclusion workbook (Excel).
Each row keeps the publisher’s action and dates. Activation waits on a review of which action types count as current.
Whether this source is screening today, and the exact file version in use, is shown on the coverage page.
What happens if it is not done
Participation actions affect the ability to provide Medicaid services.
- HCA cites WAC 182-502-0030 for actions for cause and WAC 182-502-0040 for without-cause actions omitted from the publication.
- For DSHS the page cites WAC 388-113-0020, 388-113-0030 and 388-71-0540; the separate agency publication must be checked on its own.
- The publisher cites 42 CFR 455.410(b) for enrollment and 42 CFR 1001 for federal program restrictions; it warns that not every action involves wrongdoing.
The federal exposure behind the state requirement
Where a federal health care program pays for an item or service furnished, ordered, or prescribed by a person on an exclusion list, the OIG can seek repayment of what was paid, civil monetary penalties for each item or service claimed (a statutory $10,000, adjusted annually for inflation), and an assessment of up to three times the amount claimed. The standard is what the organization knew or should have known — which is why the date of your last check is the fact that matters.
How another state’s action reaches you here
Section 6501 of the Affordable Care Act (42 U.S.C. § 1396a(a)(39), implemented at 42 C.F.R. § 455.416(c)) requires a state Medicaid agency to deny or end the enrollment of any provider that was terminated for cause on or after January 1, 2011 under Medicare, or under the Medicaid or CHIP program of any other state, and that appears in the federal termination database. In practice that means an action taken against a provider in one state reaches their participation in every other — so the list that matters to you is not only your own state's.
Common questions
The DSHS social services workbook linked by HCA lists a name, location address, DSHS license field, action date and ProviderOne ID. The complete original retrieved October4,2026 contains one provider row; this count does not prove statewide completeness. WA_DSHS metadata is separate from WA_MEDICAID; HCA activation alone does not establish DSHS coverage.
No. The DSHS workbook labels its identifier P1 ID. Preserve it as source evidence without substituting it for an NPI, license or reinstatement determination. Its Last-Modified response dates to February2025; the page’s September2026 update label is not a new retrieval date or proof each workbook changed.
No. The official page links separate HCA Medicaid and DSHS social services workbooks. This guide’s coverage key refers to HCA only; one activated source must not imply the other is screened.
No. Its page expressly omits without-cause terminations. It also warns about errors or omissions and says not every published action involves wrongdoing. Verify present participation and identity with the agency.
Some workbook cells combine a person and an associated business or contain multiple identifiers. Retain the original evidence; do not assume every name is an alias or every ProviderOne reference is an NPI.
No. The workbook has no reinstatement field. Verify present status with HCA rather than inferring restoration from elapsed time or an absent row.
A published guide or isolated local import does not establish live coverage. Consult actual source coverage metadata; operational terms review and approved first deployed activation are required.
Check one name against the federal lists, free
One name, no account, and the result states which sources it covered and which it did not. It is a spot check rather than monitoring — it does not satisfy a monthly requirement on its own.
Run a free checkOr do it for the whole roster, every month
Exclia screens every person and vendor on your roster each month against the sources we cover, and keeps the dated audit trail that shows you did it.
See pricingEvery published state in one printable table, with the source for each row and a publication date you can check. Get the state-by-state requirements table
This states what each state publishes and links to where it says it. It is not legal advice, and where your own obligations are unclear your counsel is the right reader of these sources.