Office of the Center Director
Anne Marie Costello, Deputy Director
Sara Vitolo, Deputy Director
Jessica Lee, M.D., Acting Chief Medical Officer
The Office of the Center Director (OCD) serves as the focal point for all national program policies and operations related to Medicaid, the Children's Health Insurance Program (CHIP), and the Basic Health Program (BHP). These critical health coverage programs serve millions of families, children, pregnant women, adults without children, and also seniors and people living with disabilities. The Center for Medicaid and CHIP Services (CMCS) is organized into eight groups that are responsible for the various components of policy development and operations for Medicaid, CHIP, BHP. CMCS also has an Innovation Accelerator Program (IAP) team dedicated to supporting innovation and enhancing partnerships with states. Explore the Center's organizational chart for a more detailed view of the organization.
Children & Adults Health Programs Group
The Children and Adults Health Programs Group (CAHPG) establishes national policies, including eligibility, enrollment, cost-sharing, premiums, and appeals for low-income children and adults enrolled in Medicaid; oversees all aspects of the CHIP and the BHP; as well as manages Medicaid and CHIP quality measurement and improvement strategies, and Medicaid and CHIP policy with tribal implications and outreach to tribal communities. Accordingly, CAHPG:
- Designs and simplifies eligibility policy and many of the business requirements for eligibility and enrollment systems, including coordination with the Marketplace.
- Reviews, negotiates and approves Medicaid and CHIP State Plan Amendments and BHP blueprints.
- Administers the Connecting Kids to Coverage outreach and enrollment grants.
- Works across the Center to support managed care oversight.
- Manages the development and implementation of Medicaid and CHIP quality improvement strategies, including the Medicaid/CHIP oral health strategy.
- Establishes policy and provides technical assistance on consumer satisfaction surveys, performance measurement requirements, and increasing access to care (including EPSDT). Analyzes quality measures, quality improvement, and best practices data.
- Leads CMCS’s tribal affairs work by serving as the primary liaison between CMS and American Indian/Alaska Native (AI/AN) communities including tribal leaders, health providers, beneficiaries, and other Federal agencies in regards to AI/AN health and CMS programs.
Data & Systems Group
The Data and Systems Group (DSG) is the CMCS Information Technology organization. DSG partners with states to finance, implement, and certify state Medicaid Enterprise System (MES) modules. DSG also develops and operates a suite of modern integrated digital services products aimed at streamlining how CMS receives, organizes, uses, and makes available data across all facets of state programs, enabling stakeholders a comprehensive, actionable view of effectiveness and performance. Accordingly, DSG:
- Reviews and adjudicates all state Advanced Planning Documents (APDs), as well as certain contracting documents for Information Technology (IT) projects financed with a federal match. Medicaid Enterprise System State Officers are assigned to each state and territory, and work on these processes throughout the year.
- Medicaid and CHIP Business Information and Solutions (MACBIS) -Leads development and operation of Federal IT products, such as T-MSIS, MACPro, MDP and MACFin to improve CMCS business processes, monitor and evaluate policy implementation, and provide data and information to Medicaid and CHIP stakeholders. MACBIS is an enterprise-wide initiative to ensure the Medicaid and CHIP data infrastructure and automated tools are commensurate to the programs’ role in the United States healthcare system. MACBIS consists of several related product development efforts aimed at delivering an integrated set of modern digital products to ensure CMCS delivers on its objectives.
Financial Management Group
Financial Management Group (FMG) staff around the country work collaboratively to accomplish a host of financial management oversight activities. These include providing technical assistance to states on review of institutional and non-institutional state plan amendments, review of state funding mechanisms that are specific to provider-related donations, health care-related taxes, certified public expenditures (CPEs), intergovernmental transfers (IGTs), and providing oversight of state and local appropriations to verify that they are appropriate and allowable non Federal sources of funding. Accordingly, FMG:
- Manages the Medicaid and CHIP Budget and Expenditure System (MBES/CBES), reconciles state expenditures claimed for federal matching purposes, and issues quarterly Medicaid and CHIP grant awards. FMG also manages Medicaid Disproportionate Share Hospital (DSH) and CHIP allotments.
- Reviews and analyzes fee-for-service payment and reimbursement methodologies utilized by states to pay Medicaid providers. In conjunction, reviews upper payment limit (UPL) demonstrations used to determine allowable ceilings for certain payments in the aggregate. Reviews and provides technical assistance related to claiming of administrative services i.e., cost allocation methodologies and statistical time studies.
- Reviews states’ Medicaid and CHIP quarterly estimates and statements of expenditures for Medicaid program administration and recommends appropriate actions. Provides guidance, technical assistance and policy interpretation to State agencies on financial issues, including territory financial issues. Audits selected claims to ensure appropriate payments to states and, establishes policy for and represents CMCS on all issues related to Medicaid administrative claiming.
Managed Care Group
The Managed Care Group (MCG) coordinates the Center’s work on the managed care delivery system. This group develops oversight tools for monitoring, proposes rules to enhance managed care delivery, and collaborates with providers, states, and other stakeholders to ensure beneficiaries who receive their Medicaid and CHIP benefits through managed care have a seamless experience. Accordingly, MCG:
- Monitors and provides technical assistance to states and territories to support their Medicaid and CHIP managed care programs. This includes maintaining a detailed knowledge of states’ managed care delivery systems and operational processes; providing training, guidance and technical assistance to states and implementing process improvements to support states in the provision of their managed care programs.
- Establishes Medicaid program policy for traditional managed care programs under state plan and waiver authorities. These policies ensure access, quality, and financial accountability, as well as support delivery system reform. MCG leads the review of state directed payments and supports other components’ monitoring and oversight of approved Medicaid managed care programs. MCG also collaborates with the CMS Office of the Actuary on the review of managed care rate setting proposals.
Medicaid Benefits & Health Programs Group
The Medicaid Benefits & Health Programs Group (MBHPG) has evolved its mission from an early focus on health care for persons who are disabled or elderly (originally as DEHPG), to a focus on coverage and delivery systems for all Medicaid populations, including the reform of long term services and support systems to promote community integration, and the integration of primary care, acute care, pharmacy, behavioral health and long term services and supports. Accordingly, MBHPG:
- Develops policy for delivery of health care services.
- Coordinates initiatives related to mental health, substance use disorders (SUDs), and housing-related services.
- Develops major new initiatives on SUDs, including opioid use disorder and serious mental illness.
- Oversees state plan, waiver, demonstration and grant activities that support states’ efforts to expand Medicaid and/or to develop high quality, balanced long-term services and supports systems.
- Develops all policy related to coverage, payment and rebates associated with outpatient pharmaceuticals dispensed to Medicaid beneficiaries.
- Develops policy to coordinate and integrate care for Medicaid beneficiaries also eligible for other health insurance such as Medicare or other third party payers.
Operations Services Group
The Operations Services Group (OSG) manages internal operations including budget and acquisitions, human capital and other administrative processes within the Center for Medicaid and CHIP Services. OSG is also responsible for website content and management for Medicaid.gov and InsureKidsNow.gov as well as all other media communications and outreach activities. OSG partners with CMCS Groups, CMS components, and other federal entities, in the areas of Operations and support, Budget and acquisitions, Human capital management, and Web communications. Accordingly, OSG:
- Collaborates, communicates, facilitates, and consolidates administrative and executive support requests and responses to and from CMCS and our external partners.
- Ensures operational principles are incorporated into our work to meet all Federal and Departmental requirements.
- Improves CMCS daily operations and responds to partners timely and accurately.
State Demonstrations Group
SDG supports state-led innovations in Medicaid through the design, approval / renewal, oversight and evaluation of Section 1115 demonstration projects. Accordingly, SDG:
- Serves as Agency lead for addressing emerging and precedent setting policies that require section 1115 demonstration authority.
- Provides technical assistance to senior state officials in opportunities to use section 1115 authority to close the gap in health disparities, improve coverage and access, and advance innovative approaches to service delivery and whole person care.
- Reviews and approves states’ section 1115 demonstration proposals.
- Develops budget neutrality policy and methodologies, and ensures fiscal integrity of budget neutrality agreements.
- Coordinates cross component review teams for all section 1115 demonstrations.
- Coordinates and leads federal review team members, including CMCS policy experts, the Office of Management and Budget, Office of the General Counsel, and other necessary components, in analysis of section 1115 demonstration proposals.
- Uses innovative technology and transparency principles to effectively manage projects in the demonstration review and approval process.
- Provides guidance to states on monitoring and evaluation of section 1115 demonstrations, approves state evaluation designs, reviews evaluation reports and informs the Administration on demonstration implementation and program outcomes.
- Responds to stakeholder inquiries (White House, Congress, press, provider and beneficiary advocates, etc.) about section 1115 demonstrations and about opportunities available to states.
Medicaid and CHIP Operations Group
The Medicaid and CHIP Operations Group conducts programmatic oversight, monitoring and provides technical assistance to state Medicaid agencies to ensure effective implementation of federal rules in the administration of the Medicaid and CHIP programs across the country. Accordingly, MCOG:
- Adjudicates state actions including State Plan Amendments, 1915(b) and (c) waivers, HCBS deliverables, and 1135 waivers.
- Conducts monitoring & oversight of state HCBS programs and section 1115 demonstrations.
- Provides technical assistance to states, tribes and stakeholders, serving as the State Initial Point of Contact.
- Serves beneficiaries by responding to inquiries, conducting Marketplace and other beneficiary casework.
- Coordinates CMCS’ response to public health emergencies (PHE) and natural disasters.
Innovation Accelerator Program
The Innovation Accelerator Program supports CMCS-wide initiatives with the end goal of improving Medicaid/CHIP agencies’ capacity to implement delivery system reforms. IAPSS accomplishes this mission through activities such as:
- Publishing public reporting tools and technical resources such as the Medicaid and CHIP Scorecard.
- Developing technical resources to support CMCS's goals to improve access in Medicaid & CHIP such as 2022 Access Request for Information and the Access data analytic brief.