The CMSP Governing Board was established by California law in April 1995. The Board has overall program and fiscal responsibility for CMSP. Under its authorities set forth in Welfare and Institutions Code Section 16809 et seq, the Governing Board has responsibility for setting program eligibility standards, defining the scope of covered healthcare benefits, and determining payment rates for healthcare providers delivering emergency and non-emergency services to CMSP members.

The Governing Board is composed of eleven members. Ten members are county officials who are elected by the thirty-four participating CMSP counties. These officials include three County Supervisors, three County Administrative Officers, two County Health Officials and two County Welfare Directors. One member of the Governing Board is an ex-officio, non-voting representative of the Secretary of the California Health and Human Services Agency.