John Giles joined the Centers for Medicare & Medicaid Services (CMS) in 2014 and is currently the Director for the Managed Care Group (MCG) within the Center for Medicaid and CHIP Services (CMCS). In this role, John leads and directs all of the Medicaid managed care policy and operations across several primary portfolios of work, including Medicaid managed care policy development, delivery system and provider payment initiatives (State directed payments), in lieu of services and settings (ILOS), capitation rate development, Medicaid managed care medical loss ratios (MLRs), Federal Medicaid managed care authorities, managed care plan contract oversight, Medicaid managed care program monitoring and oversight, and Medicaid managed care strategy and performance management. 

 

Specifically, John leads and directs CMS’s work on all aspects of the nation’s Medicaid managed care delivery system. John oversees the development of oversight tools for monitoring, proposes rules and policy to enhance managed care delivery, and collaborates with providers, states, and other stakeholders to ensure beneficiaries who receive their Medicaid benefits through managed care have a seamless experience. John leads the Managed Care Group to establish program policy that ensures access to care, high quality of care, and prudent financial accountability, as well as supports delivery system reform, across the nation’s Medicaid managed care programs. 

 

John has served in a number of Federal roles within CMCS, including as the Director for the Division of Managed Care Policy (DMCP), Senior Policy Advisor to the Center Director, and Technical Director for managed care policy. John has also been the principal author for several significant Medicaid managed care Federal regulations, including the recent 2024 final Medicaid managed care rule on access, finance, and quality, as well as the 2016, 2017, and 2020 Medicaid managed care final rules. 

 

Prior to joining CMS, John served in a mix of leadership roles in the State of Oklahoma, including as the Director of the Center for Health Innovation and Effectiveness for the Oklahoma State Department of Health and Senior Policy Advisor for the Oklahoma Health Care Authority. John has 18 years of experience in Federal and State Medicaid policy and operations. John received a Master of Public Administration (MPA) from the University of Oklahoma and a Bachelor of Arts (BA) from the University of Central Oklahoma.