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 information related to enrollment, care delivery, program improvement efforts, expenditures, and improper payments.
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.
| Who Enrolls in Medicaid & CHIP? | Recent enrollment statistics for Medicaid and CHIP, such as enrollment by age, sex, and state. |
| How do States Deliver Care in Medicaid? | Examples of the ways states can vary in benefit coverage and how they deliver care. |
| What Data are CMS & States Developing to Support Program Improvement? | Examples of the ways states and CMS collaborate to develop nationally standardized data to support quality improvement activities. |
| What are Annual Expenditures for Medicaid & CHIP? | Recent expenditure statistics for Medicaid and CHIP, including annual Medicaid and CHIP expenditures, Medicaid per capita expenditures, and long-term services and supports expenditures on home & community-based services. |
| What is the Rate of Improper Payments in Medicaid & CHIP? | Recent national improper payment rate statistics for Medicaid and CHIP, including overall improper payment rates and improper payment rates for fee-for-service, managed care, and eligibility. |