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.

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Featured publications

Improving the Effectiveness of Medicaid Program Integrity

June 2019 |

Medicaid program integrity (PI) activities are meant to ensure that taxpayer dollars are spent appropriately on delivering high-quality and necessary care, and preventing and detecting fraud, waste, and abuse. State Medicaid programs have primary responsibility for PI, which includes a wide range of activities, some of which are specific to PI while others are embedded […]

Building Capacity to Administer Medicaid and CHIP

June 2014 |

In Chapter 4 of the June 2014 report, the Commission looks at the role of state and federal administrative capacity–people, systems, and data–in managing Medicaid and CHIP most efficiently and effectively. This chapter describes the administrative requirements for state Medicaid programs, obstacles states and the federal government face in administering Medicaid, and models and strategies […]

Update on Medicaid and CHIP Data for Policy Analysis and Program Accountability

June 2013 |

Chapter 4 of MACPAC’s June 2013 report focuses on the importance of having accurate, timely, and nationally comparable data on Medicaid and the State Children’s Health Insurance Program (CHIP) to answer key policy questions that affect enrollees, states, the federal government, health care providers, and others, as well as to ensure accountability for taxpayer dollars. […]