MediCaid
Medicaid is a U.S. federal-state entitlement health coverage program administered by CMS, serving eligible low-income individuals, children, pregnant women, disabled persons, and seniors across all 50 states through state agencies, managed care plans, and provider partnerships.
- Company typePublic
- Founded1965
- HeadquartersBaltimore, United States
- Headcount1–10
- GTM typeB2C
- OfferingServices
What MediCaid does
Medicaid is a U.S. federal-state entitlement health coverage program established in 1965 through the Social Security Amendments and administered at the federal level by the Centers for Medicare and Medicaid Services (CMS), an agency within the U.S. Department of Health and Human Services. The program serves eligible low-income adults, children, pregnant women, individuals with disabilities, and seniors, with specific initiatives addressing infants and toddlers with disabilities under Part C of IDEA, adults with opioid use disorder, justice-involved populations, and individuals with dementia and their caregivers. Core products include Medicaid State Plan Amendments, Section 1115 Demonstrations, CHIP, Health Homes, Home and Community-Based Services, Managed Care delivery, the Prescription Drug Rebate Program, EPSDT child health benefits, School-Based Services, and Long Term Services and Supports.
The program's technology stack consists of internal government platforms rather than consumer-facing software: MACPro for state plan amendment management, the Medicaid Data Collection Tool (MDCT) portal housing CARTS, SEDS, QMR, MCR, and MFP subsystems, MC-Review for managed care contract submissions, and OneMac for SPA and waiver processing. There is no public API, no mobile application, and no documented AI or machine learning capability. The supporting infrastructure includes the MAC Learning Collaboratives for federal-state technical assistance, the Disaster Response Toolkit, and resources for implementing the Working Families Tax Cut Legislation.
Medicaid operates as a joint federal-state partnership with no commercial revenue model. States administer programs within federal guidelines, receiving federal matching funds, and distribute benefits through contracted managed care organizations, fee-for-service providers, school-based local educational agencies, and justice system partnerships. The program is publicly owned, governed by federal statute, and not subject to private equity, venture financing, or traditional competitive dynamics; its scale and trajectory are determined by congressional appropriations, state participation decisions, and CMS policy guidance rather than market forces.
MediCaid firmographics
Firmographics- Name
- MediCaid
- Legal name
- Centers for Medicare & Medicaid Services
- Website
- https://medicaid.gov
- Company type
- Public
- Founded year
- 1965
- Operating status
- Operating
- Headcount range
- 1–10 employees
- Short description
- Medicaid is a U.S. federal-state entitlement health coverage program administered by CMS, serving eligible low-income individuals, children, pregnant women, disabled persons, and seniors across all 50 states through state agencies, managed care plans, and provider partnerships.
- Ownership category
- akta.pro rank
MediCaid industry classification
Industry- Product category
- Public Health Insurance
- NAICS
- Health and Welfare Funds (52512), Social Assistance (624), Individual and Family Services (6241), Services for the Elderly and Persons with Disabilities (624120)
- SIC
- Hospital & Medical Service Plans (6324), Services-Health Services (8000), Services-Social Services (8300)
- akta.pro primary industry
- Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH)
- akta.pro secondary industries
- Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB), Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI), Medicaid/CHIP Dental & Vision Benefits Administration (FSAIAHAK)
Keywords
Where MediCaid is headquartered
LocationHeadquarters
- HQ city
- Baltimore
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
MediCaid business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Operations, Infrastructure, Personnel, Technology or R&D, Others
Distribution channels4 records
Marketing channels3 records
MediCaid product offering
Product offeringCore offering
Medicaid is a U.S. federal-state entitlement program administered by CMS that provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities across all 50 states, the District of Columbia, and territories. Its core offering is a defined benefit package that includes mandatory and optional services such as physician visits, hospital care, prescription drugs, EPSDT for children, home and community-based services, managed care, and long-term services and supports. The program funds these benefits through a federal-state matching model, with state Medicaid agencies administering day-to-day eligibility and operations within federal guidelines, and supports Section 1115 demonstration waivers for delivery and payment innovation.
Product overview
Medicaid.gov is the official U.S. government portal for Medicaid, CHIP, and Basic Health Programs—a suite of federal-state health coverage programs. The platform provides state plan amendment management, Section 1115 demonstration approvals, Health Homes for chronic condition care coordination, Home & Community-Based Services, Managed Care oversight, Prescription Drug coverage administration, EPSDT child health benefits, School-Based Services, and Long Term Services & Supports. Supporting infrastructure includes MAC Learning Collaboratives for federal-state technical assistance, the MDCT Portal for data collection (CARTS, SEDS, QMR, MCR, MFP), MC-Review for managed care contract submissions, and Disaster Response Toolkit. Recent policy initiatives include Working Families Tax Cut Legislation implementation resources and Community Engagement requirements.
Differentiator
Problem solved
Functional benefit
Products and services
- Children's Health Insurance Program (CHIP) Federal-state health coverage program for children in families with income above Medicaid eligibility limits but below specified thresholds, administered jointly with Medicaid.
- Health Homes Coordinated care model for Medicaid beneficiaries with chronic conditions, integrating primary care, behavioral health, and long-term services and supports under Section 1945 of the Social Security Act.
- Home & Community-Based Services (HCBS) Medicaid programs enabling eligible beneficiaries to receive long-term services and supports in home and community settings rather than institutional settings.
- Managed Care State Medicaid delivery system in which contracted health plans deliver the defined Medicaid benefit package to enrolled beneficiaries.
- Prescription Drugs (Medicaid Drug Rebate Program) Medicaid outpatient prescription drug coverage including the Drug Rebate Program with manufacturers, pharmacy pricing, and utilization review administration.
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Comprehensive, mandatory Medicaid child health benefit providing screening, diagnostic, and treatment services for enrollees under age 21.
- School-Based Services Medicaid-covered health services delivered in school settings to eligible students through local educational agencies (LEAs).
- Long Term Services & Supports Institutional and community-based long-term services and supports for Medicaid beneficiaries needing extended care, including nursing facility and home-based care.
- Basic Health Program State option established under the Affordable Care Act to provide health coverage to individuals with income above Medicaid eligibility but below 200% of the federal poverty level.
- Section 1115 Demonstrations Section 1115 waiver and demonstration authority that allows states to test innovative approaches to Medicaid delivery and financing subject to federal approval.
- Medicaid State Plan Amendments Federal approval mechanism through which states modify their Medicaid state plans covering benefits, eligibility, and provider payment methodologies.
Quantifiable outcome
- Medicaid provides early intervention to over 540,000 infants and toddlers with disabilities, showing reduced need for special education and improved social-emotional skills
- +1 more outcomes
Companies that use MediCaid
Customer profileNamed customers5 records
Segments5 records
Ideal customer profiles5 records
MediCaid technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
MediCaid partnerships and signals
Strategic signalPartnerships
Ten partnerships are on record, tiered core and secondary.
- Center for Medicare & Medicaid Innovation (CMMI)coreCollaborative partnership between CMCS and CMMI to administer the Medicaid Innovation Accelerator Program (IAP) from 2014-2020, focusing on payment and delivery system reforms
- State Medicaid AgenciescoreStates partner with federal government to implement Medicaid programs, receiving technical assistance through IAP for delivery system reforms including SUD treatment, complex care, and LTSS
- U.S. Department of EducationcoreJoint effort with Department of Education to expand school-based health services through Medicaid School-Based Services Technical Assistance Center (TAC), as mandated by Bipartisan Safer Communities Act Section 11003
- SAMHSA (Substance Abuse and Mental Health Services Administration)corePartnership for behavioral health crisis care continuum, including 988 Suicide & Crisis Lifeline implementation and guidance on SUD treatment under Section 1115 demonstrations
- HRSA (Health Resources and Services Administration)secondaryFederal partnership for school health resources and mental health system support
- CDC (Centers for Disease Control and Prevention)secondaryPartnership for school health resources, mental health data, and youth health initiatives
- MathematicasecondaryContracted by CMS to coordinate MAC Learning Collaboratives activities with state and federal officials
- Manatt Health SolutionssecondaryContracted by CMS to coordinate MAC Learning Collaboratives activities
- Medicaid Technology CompaniescoreCompanies pledged $600 million in savings to support community engagement implementation and related state Medicaid system improvements under Working Families Tax Cut legislation
- State Medicaid Agencies (MDCT data collection)coreStates use Medicaid Data Collection Tool (MDCT) portal to report data to CMS including CARTS, SEDS, QMR, MCR, and MFP systems
Scale indicators4 records
Recent moves6 records
Expansion highlights5 records
MediCaid competitors and assessment
Company assessmentBroad incumbents
- Centers for Medicare & Medicaid Services (CMS): CMS is the parent federal agency that administers Medicaid, Medicare, CHIP, and the Health Insurance Marketplaces. It is the closest organizational peer because Medicaid operates as a program within CMS and shares its federal administrative infrastructure.
- Medicare: Medicare is the sister federal health entitlement covering Americans 65+ and certain disabled populations. It is highly comparable because Medicaid wraps around Medicare for dual-eligibles and shares the same CMS administrative framework, beneficiary concepts, and federal-state partnership logic.
- Veterans Health Administration (VA): The VA operates the largest integrated U.S. federal healthcare system for veterans. It is a broad incumbent peer as another federal entitlement-style health program delivering comprehensive care to an eligibility-defined population.
Direct peers
- Children's Health Insurance Program (CHIP): CHIP is a joint federal-state program that provides health coverage to children in families with incomes above Medicaid limits. It is administered alongside Medicaid within CMS and shares the same state-plan, managed-care, and Section 1115 waiver mechanics.
- Centene Corporation: Centene is the largest Medicaid managed-care insurer in the U.S., administering benefits on behalf of state Medicaid programs for tens of millions of beneficiaries. It is a direct operating peer because Medicaid programs contract with MCOs like Centene to deliver the benefits Medicaid defines.
- UnitedHealth Group (Optum/UnitedHealthcare): UnitedHealthcare is one of the largest Medicaid managed-care operators and also a major dual-eligible/Medicare Advantage carrier. It is a direct peer as a state-contracted MCO delivering Medicaid benefits and integrating with dual-eligible programs.
- Elevance Health (Anthem): Elevance Health's Anthem Blue Cross Blue Shield plans are among the largest Medicaid MCOs in multiple states. It is a direct peer as a managed care partner that administers Medicaid benefits on a state-contract basis.
- Humana: Humana is a major participant in Medicaid managed care (and the largest Medicare Advantage carrier). It is a direct peer in Medicaid for its state-contracted MCOs serving TANF, ABD, and dual-eligible populations.
- Molina Healthcare: Molina Healthcare is a Medicaid-focused health plan that derives the majority of its revenue from state Medicaid contracts. It is a direct peer as a government-program-focused managed care operator with concentrated Medicaid exposure.
Others
- HealthCare.gov (ACA Marketplace): The Federally Facilitated Marketplace exchanges ACA subsidized coverage and coordinates eligibility with Medicaid. It is an adjacent peer because Medicaid applicants are screened for Marketplace eligibility and vice versa, and it shares the MAGI eligibility logic.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat4 records
Key risks5 records
Key highlights6 records
Customer concentration
MediCaid social profiles
Digital presenceMediCaid financial estimates
Financial estimateRevenue estimate
Valuation estimate
MediCaid leadership team
Management profileNumber of profiles
MediCaid funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
MediCaid M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about MediCaid
What does MediCaid do?
Medicaid is a U.S. federal-state entitlement program administered by CMS that provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities across all 50 states, the District of Columbia, and territories. Its core offering is a defined benefit package that includes mandatory and optional services such as physician visits, hospital care, prescription drugs, EPSDT for children, home and community-based services, managed care, and long-term services and supports. The program funds these benefits through a federal-state matching model, with state Medicaid agencies administering day-to-day eligibility and operations within federal guidelines, and supports Section 1115 demonstration waivers for delivery and payment innovation.
Is MediCaid a public or private company?
MediCaid is a public company. It is classified as state government owned and is currently operating.
When was MediCaid founded?
MediCaid was founded in 1965. It employs 1 to 10 people.
Where is MediCaid based?
MediCaid is headquartered in Baltimore, United States, in the North America region.
Who are MediCaid's main competitors?
Broad incumbents on record are Centers for Medicare & Medicaid Services (CMS), Medicare and Veterans Health Administration (VA). Direct peers are Children's Health Insurance Program (CHIP), Centene Corporation, UnitedHealth Group (Optum/UnitedHealthcare), Elevance Health (Anthem), Humana and Molina Healthcare. HealthCare.gov (ACA Marketplace) is listed as an others.
Does MediCaid have an API?
No public API is recorded for MediCaid.
What industry is MediCaid in?
MediCaid's product category is Public Health Insurance. Its primary akta.pro industry code is BPAIAKAH, Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage), with a secondary code of HLAEAEAB, Medicaid Expansion (ACA Adult) Managed Care Plans. Its NAICS code is 52512 and its SIC code is 6324.