National Context

The Scorecard increases transparency into the administration and outcomes of Medicaid and the Children’s Health Insurance Program (CHIP). The data in this section help explain the Medicaid and CHIP programs by highlighting:

  • Who enrolls in Medicaid and CHIP
  • Medicaid and CHIP expenditures compared to other health care payers and by service category
  • State efforts to collect and report data that support ongoing program improvement 

States establish and administer their own Medicaid and CHIP programs. As a result, the populations and benefits covered by Medicaid and CHIP vary across states. For example, in all states Medicaid provides health care coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities.  In some states Medicaid also covers all low-income adults below a certain income level. This group is sometimes called “expansion adults.” In CHIP, states can choose to set income levels higher than the federal minimum threshold, and to cover pregnant women. Federal law also requires states to provide certain “mandatory” benefits and allows states to cover other “optional” benefits in Medicaid and CHIP. States deliver Medicaid and CHIP benefits by directly paying providers – called “fee-for-service” payments – or through contracted arrangements with managed care organizations that oversee benefit delivery.

Future Scorecards will include more information. The information will describe the differences in Medicaid and CHIP programs across states, as well as explain the role of these programs in the broader health care system.