Program Administration
The Centers for Medicare & Medicaid Services (CMS) and the individual states and territories jointly administer Medicaid and the State Children’s Health Insurance Program (CHIP). CMS is responsible for program administration at the federal level. CMS approves state plans and state plan amendments, waivers, and demonstration programs; enforces compliance; and provides guidance to states.
Learn More about These Topics
- Medicaid administrative data
- Payment Error Rate Measurement (PERM)
- State plan
- Waivers
- Program integrity
Featured Publications
Comment Letter: Medicaid Program Integrity
March 30, 2026
In response to a Centers for Medicare & Medicaid Services (CMS) request for information on combatting fraud, waste, and abuse in federal health care programs, MACPAC outlined four areas where we have evidence-based findings and recommendations: identifying and eliminating ineffective or redundant program integrity (PI) activities and requirements, promoting high-value PI activities, barriers to PI […]
Provider Enrollment and Credentialing in Medicaid
March 5, 2026
Medicaid provider enrollment and managed care credentialing aim to ensure that Medicaid enrollees receive care from qualified providers. As part of the Commission’s continued focus on access to care for Medicaid enrollees, MACPAC examined federal and state policies as well as academic and grey literature pertaining to Medicaid provider enrollment and credentialing. In this session, […]
Automation in the Prior Authorization Process
February 27, 2025
Recent years have seen growth in the use of technology, including artificial intelligence (AI), to automate parts of the Medicaid prior authorization process. However, there is little information available today about how automation is used in Medicaid prior authorization and its impact on payers, providers, and Medicaid beneficiaries. To fill this gap in knowledge, staff […]