Top 10 Best Medicaid Software of 2026

Epic Systems offers a comprehensive EHR platform with robust Medicaid-specific capabilities, including real-time eligibility verification, claims management, enrollment processing, and compliance reporting through modules like Healthy Planet and the Payer Platform. It integrates seamlessly with clinical workflows to support population health management for Medicaid beneficiaries, enabling value-based care and risk stratification. Designed for large-scale deployment, it handles high-volume Medicaid claims and prior authorizations efficiently while ensuring regulatory compliance across states.

Oracle Cerner, now part of Oracle Health, offers a robust electronic health record (EHR) platform with specialized modules for Medicaid management, including enrollment, eligibility checks, claims processing, and care coordination. Its HealtheIntent population health platform enables real-time analytics and risk stratification for Medicaid populations, supporting value-based care and compliance with federal regulations. The solution integrates deeply with state Medicaid systems and provides tools for prior authorizations, utilization management, and provider networks.

athenahealth is a comprehensive cloud-based EHR and practice management platform that supports healthcare providers with electronic health records, revenue cycle management, and patient engagement tools. It excels in handling Medicaid-specific workflows, including automated claims submission, eligibility verification, prior authorizations, and denial management to ensure compliance and maximize reimbursements. The athenaOne suite integrates seamlessly with the athenahealth payer network for efficient processing across multiple Medicaid programs.

Gainwell Technologies provides comprehensive Medicaid enterprise software solutions, including modular Management Information Systems (MMIS), eligibility platforms, pharmacy point-of-sale systems, and care management tools tailored for state agencies. These solutions handle claims adjudication, provider management, member enrollment, and compliance with federal CMS requirements at scale. Leveraging cloud-based architecture and advanced analytics, Gainwell enables efficient operations, fraud detection, and data-driven policy decisions for complex Medicaid programs.

Conduent provides enterprise-grade Medicaid management software and services, including eligibility determination, claims adjudication, provider management, and care coordination platforms tailored for state agencies. Their solutions, such as the Homecare Suite and eligibility systems, support high-volume processing for millions of enrollees while ensuring HIPAA and CMS compliance. With a focus on business process outsourcing integration, Conduent helps streamline Medicaid operations from enrollment to payment.

Optum offers a comprehensive Medicaid software platform designed for managed care organizations, focusing on claims processing, eligibility management, provider contracting, and care coordination. Leveraging UnitedHealth Group's extensive data resources, it provides advanced analytics for population health management, risk adjustment, and utilization review to optimize Medicaid program performance. The solution supports end-to-end operations from enrollment to payment integrity, with strong emphasis on compliance and value-based care.

eClinicalWorks is a comprehensive EHR and practice management platform designed to support Medicaid providers with features like electronic claims submission, real-time eligibility verification, and automated remittance processing. It integrates patient records, scheduling, billing, and reporting tools to ensure compliance with Medicaid regulations and quality measures such as HEDIS. The system also offers telehealth, patient portals, and analytics for population health management, making it suitable for ambulatory practices and FQHCs serving Medicaid populations.

NextGen Healthcare provides a comprehensive EHR and practice management platform tailored for ambulatory care, with strong support for Medicaid billing, claims submission, and eligibility verification. It streamlines revenue cycle management (RCM) through automated scrubbing, real-time payer checks, and compliance reporting specific to Medicaid requirements. The software integrates with clearinghouses and offers population health tools to manage high-volume Medicaid patient populations effectively.

ZeOmega's Jiva platform is a comprehensive enterprise management solution tailored for health payers, including Medicaid managed care organizations, offering integrated tools for care management, utilization review, population health analytics, and claims processing. It enables Medicaid plans to coordinate care for high-risk populations, ensure regulatory compliance, and optimize costs through advanced workflows and member engagement features. With strong interoperability and configurable rules engines, Jiva supports value-based care models prevalent in Medicaid.

HealthEdge delivers cloud-native software solutions tailored for health payers, including Medicaid managed care organizations, through its flagship HealthRules Payer platform. This comprehensive system handles core administrative functions such as claims processing, member enrollment, provider network management, and benefits configuration. It emphasizes modularity, scalability, and compliance with complex Medicaid regulations, supporting transitions to value-based care.