CMS recently announced a reorganization of the regional and central offices that oversee Medicaid and CHIP. It’s too soon to tell how the re-org will impact the day-to-day operations of Medicaid and CHIP, but the federal register notice says that the new structure will support consistent policy implementation and accountability.

You may not have even realized that CMS has ten regional offices, spread across the country and organized by four consortia. But much of the federal work ensuring smooth operations of Medicare and Medicaid happens in these regional offices, and the regional offices are the first point of contact for state Medicaid policy staff when connecting with their federal counterparts. Nationally, Medicaid and CHIP policy and operations are overseen by the Baltimore-based Center for Medicaid and CHIP Services (CMCS), but the local regional offices plus the Chicago-based Consortium for Medicaid and Children’s Health Operations (CMCHO) serve as the local contacts.

Here’s how these pieces fit into the org chart under the old model – the CMCHO Administrator reported up to the Chief Operating Officer, who in turn reported up to the CMS Administrator. Meanwhile the CMS Administrator also oversaw six Centers responsible for running Medicare and Medicaid, including CMCS. Under the new model, CMCHO is one of seven groups that report up to the CMCS Director, who in turn reports up to the CMS Administrator.

Thankfully we’re not here to keep tabs on the org chart (groups, centers, and administrators, oh my!). What we’d like to know is what does this reorganization mean? How will it impact day-to-day operations of Medicaid and CHIP? How will it impact Medicaid and CHIP policy decisions?

It’s too soon to tell. There is potential for improvement. For example, regional offices are tasked with reviewing Medicaid managed care contracts and this move could make those reviews more consistent across the country. Nine out of ten children covered by Medicaid/CHIP are in some type of managed care delivery system and thorough, consistent oversight is needed to make sure children are getting all of the services needed to grow and thrive. But this move could also be a setback. If more policy decisions are made by regional offices, that could lead to even greater variation in Medicaid and CHIP, widening existing disparities by region, state and zip code. We’ll keep watching as the reorg takes shape.