Connecticut, Michigan, and New York have successfully used Medicaid administrative data to conduct surveillance of asthma prevalence, related health service utilization and costs, and quality of asthma care. Since these assessments utilize beneficiary-level data, a wide range of population-based summaries is feasible. Opportunities exist to build upon the collective experiences of these three states to establish a national framework for asthma surveillance using Medicaid administrative data. This framework could be designed to respond to each state's unique data considerations and asthma management priorities, while establishing standardized criteria to enhance the comparability of asthma surveillance data among states. Importantly, a common asthma case definition using comparable methods is necessary to enable comparisons of prevalence estimates between states. Case definitions that could serve as the foundation for such a framework are presented. Mechanisms to foster sharing of methodologies and experiences will be instrumental for broad implementation across states. This collaboration will be of increasing importance as states experience mounting financial pressures due to increasing Medicaid enrollment and dwindling resources.