The Data and Systems Group (DSG), within the Center for Medicaid and CHIP Services (CMCS), provides oversight, funding, technical assistance, and guidance to state Medicaid agencies for the Medicaid Information Technology (IT) Enterprise. States’ systems enable efficient operations of the Medicaid and CHIP Programs by supporting beneficiary eligibility, enrollment, care management, and other beneficiary-facing tools. These systems also serve provider enrollment and payment, benefits managements, data analytics and reporting, fraud and abuse detection, and provider electronic health record incentive payments. On average the federal share for the development and operations of these systems tops $5 billion annually.
DSG builds and operates numerous systems for CMS’ mission that compile key program data to help stakeholders assess program performance, beneficiary eligibility, quality and clinical metrics, provider enrollment; and that track pharmacy rebates, federal financial participation to states and that capture states’ waivers, quality measures and state plan amendments.