Medicine Hat's City Council consists of a Mayor and eight Aldermen. Council is responsible for developing and evaluating the policies and programs of the municipality, and delegating the responsibility for carrying out those policies to Administration. The public is encouraged to attend regular council meetings, which are held the first and third Mondays of each month, in City Hall Council Chambers.

The City of Medicine Hat plans strategically for the future. The organization focuses on where it wants to go and how to get there. The City's strategic plan supports Council's vision, mission and direction.

Senior Administration consists of a Chief Administrative Officer, and Commissioners of Energy, Public Services, Corporate Services and Development and Infrastructure. In addition to the commissioners, the City Clerk and City Solicitor make up an Executive Team.