Medicaid/CHIP Provider Relief Fund Payment Forms and Guidance

The Department of Health and Human Services (HHS) expects to distribute $15 billion to eligible Medicaid and CHIP providers through the Coronavirus Aid, Relief and Economic Security (Cares) Act.  Important Details include:

Eligibility: Any provider that did NOT receive a funding award from the first $50 billion in awards made to providers with some level of Medicare utilization, and directly billed a state Medicaid program or Medicaid managed care plan between January 1, 2018 and May 31, 2020.

Payment Amounts: The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.

Before applying through the enhanced provider relief portal, applicants should:

Read the Medicaid Provider Distribution Instructions - PDF*
Download the Medicaid Provider Distribution Application Form - PDF*