Medicaid Oversight Governance Map

June 16, 2026 | Orobosa Idehen, Madoc Alder Marshall

With integral roles in the health care safety net, both public health and Medicaid agencies can advance state-level efforts to improve population health through strategic partnerships and joint policy efforts. The Medicaid Oversight Governance Map provides an overview of state/territorial health agency governance structures, specifically:

Organizational approach, including whether Medicaid and public health are housed within the same agency.
Whether the state/territorial health official has oversight of Medicaid and the Children’s Health Insurance Program.

This map provides public health leaders with a baseline understanding of public health and Medicaid program structure and oversight. It can help health agency staff understand the relationship between public health and Medicaid programs in their jurisdiction, and identify other health agencies with similar levels of influence or authority.

Terms

State/Territorial Health Agency (S/THA): A governmental unit responsible for protecting and promoting the health of residents within a specific U.S. state or territory.
Freestanding Agency: An independent agency within the state government.
Umbrella Agency: An agency that is a unit of a larger combined health and human services organization, also referred to as a super agency. For this map, the umbrella category assumes the Medicaid division is part of the S/THA.
State/Territorial Health Official (S/THO) Oversight: An ASTHO member has oversight of Medicaid in a S/THA within an umbrella governance structure.

Note: S/THA governance of Medicaid differs from ASTHO member oversight of Medicaid. ASTHO allows states to determine their ASTHO member. In some states, the S/THO designee exercises governance over the public health division or related divisions while another leader (typically the state Medicaid director) has direct oversight of Medicaid. 

Data Sources

ASTHO used an internal database of S/THA information and agency organizational charts for each state. Each state’s organizational chart is linked in the map.
2022 Profile data from 58 jurisdictions helped inform their governance classification (centralized, mixed, decentralized, shared), structure (freestanding/independent, under an umbrella), and responsibility for Medicaid (umbrella has responsibility or N/A).
ASTHO’s “State Health Agency Workforce Characteristics” report was used to standardize term definitions.