Regulations governing health insurance programs are spread across various levels of government: the Medicare program is a federal program managed by the Department of Health and Human Services; Medicaid and CHIP are programs jointly funded by the federal government and the states where the federal government establishes a framework for the program and states make specific program choices. The states regulate plans in the small group and individual markets under a framework established in the Affordable Care Act, but details vary across states. For example, a few states use community rating, while factors used for experience rating across states may vary and include some of the factors listed here. (Some states include tobacco use as a factor for experience rating.) Regulatory requirements vary across states: The Department of Labor oversees large group and self-insured plans.