Document Type


Publication Date



Medicaid, Disability and Aging, Cutler Institute, USM Aging Initiative, Policy, Health and Wellness


Today, the Medicaid program is evolving more rapidly than at any other time in its fifty-year history. States and the federal government are working to maximize the value and efficiency of Medicaid by reforming payment to reward value over volume, integrating effective care coordination across payers, and streamlining key processes like eligibility determinations across coverage programs. Underpinning a state’s ability to implement these reforms is its capacity to manage its Medicaid program effectively and efficiently.

This paper discusses key responsibilities that the federal government and states hold for managing the Medicaid program and identifies the key issues and challenges states face as they transform the way they do business and achieve key national goals. The paper relies on an extensive review of federal and state responsibilities drawn from statute, regulation, and relevant literature, coupled with discussions with six current Medicaid directors, who graciously volunteered their time and observations on the opportunities and challenges they face in administering their state Medicaid programs.