Center for Medicaid and Chip Services

The Centers for Medicare and Medicaid Services (CMS), a sub-agency of the Department of Health and Human Services, administers federal grant funding for state Medicaid programs, territorial health departments, and related health-care delivery systems. CMS obligated $21.269 trillion in combined federal grant dollars across 2,936 awards since 2007, with grant activity declining in recent years: 288 awards in 2022, 196 in 2023, 210 in 2024, 257 in 2025, and 1 year-to-date in 2026. The most recent recorded award date is May 1, 2026.

Grant recipient concentration is moderately concentrated. The top five recipients by award count over the last five years hold 16 percent of recent awards: Government of Guam Department of Administration (33 awards, $2.37 billion federal dollars), Puerto Rico Department of Health (32 awards, $40.78 billion federal dollars), Department of Public Health Division IV (32 awards, $1.46 billion federal dollars), Virgin Islands Department of Health (31 awards, $5.6 billion federal dollars), and American Samoa Medicaid Agency (26 awards, $663.4 million federal dollars). By federal dollars obligated, the top five recipients hold 28 percent of recent funding: California Department of Health Care Services leads with 18 awards and $3.805 trillion federal dollars, followed by Pennsylvania Department of Human Services ($646.58 billion across 17 awards), North Carolina Department of Health and Human Services ($491.59 billion across 16 awards), Arizona Health Care Cost Containment System ($481.19 billion across 16 awards), and Michigan Department of Health and Human Services ($455.85 billion across 15 awards). The portfolio spans 69 distinct grant recipients, indicating a broad recipient base dominated by state Medicaid agencies and territorial health administrations.

Grants are predominantly structured as Block Grants (1,818 awards, 62 percent) and Formula Grants (1,073 awards, 37 percent), with Project Grants and Cooperative Agreements representing less than 2 percent combined. Block and Formula Grant structures align with CMS's statutory role in distributing federal Medicaid funds to states and territories under fixed or population-based allocation formulas, with little discretionary project-grant activity. The sharp drop in award volume year-to-date in 2026 suggests seasonal or administrative timing patterns rather than program wind-down; the May 2026 award date indicates recent transactional activity despite low year-to-date counts.