Director, Managed Care Group
Center for Medicaid and CHIP Services (CMCS)
Centers for Medicare & Medicaid Services
John Giles is the Director for the Managed Care Group (MCG) within the Center for Medicaid and CHIP Services (CMCS) at the Centers for Medicare & Medicaid Services (CMS). In this role, John leads and directs the Medicaid managed care policy and operations across several primary portfolios of work, including Medicaid managed care policy development, delivery system and provider payment initiatives (State directed payments), in lieu of services and settings (ILOS), capitation rate development, Medicaid managed care medical loss ratios (MLRs), Federal Medicaid managed care authorities, managed care plan contract oversight, and Medicaid managed care strategy and performance management.
John initially joined CMS in 2014 and has served in a number of Federal roles within CMCS, including as the Director for the Division of Managed Care Policy (DMCP), Senior Policy Advisor, and Technical Director for managed care policy. John has also been a principal author for several Medicaid managed care Federal regulations, including the 2023 proposed managed care rule on access, finance, and quality, as well as the 2016, 2017, and 2020 Medicaid managed care final rules.
Prior to his work at CMS, John served in a mix of roles for the State of Oklahoma, including as the Director of the Center for Health Innovation and Effectiveness for the Oklahoma State Department of Health and Senior Policy Advisor for the Oklahoma Health Care Authority. John has 17 years of experience in Federal and State Medicaid and CHIP policy and operations. John received a Master of Public Administration (MPA) from the University of Oklahoma and a Bachelor of Arts from the University of Central Oklahoma