Who is responsible for administering Medicaid?

The administration of Medicaid is primarily the responsibility of the states, which operate their own Medicaid programs within federal guidelines. While the federal government provides funding and sets overarching rules for the Medicaid program, each state has the authority to design its program and determine eligibility criteria, benefits, and payment rates for healthcare providers. The Centers for Medicare & Medicaid Services (CMS) oversees these state Medicaid programs to ensure compliance with federal regulations and manage federal funding effectively.

This structure allows states the flexibility to tailor their Medicaid programs to meet the specific needs of their populations, but it also requires that they align with federal laws and maintain certain standards. The role of CMS is vital in providing oversight, ensuring that states follow established policies and that beneficiaries receive appropriate coverage.

Other entities, such as local health departments and private agencies, may play supportive roles in the healthcare system, but they do not hold the primary responsibility for administering Medicaid.