TheCenters for Medicare and Medicaid Services (CMS) manages funding for public healthcare programs such asMedicaid,Medicare, theChildren's Health Insurance Program (CHIP), and thehealth insurance exchanges created by theAffordable Care Act. The agency's mission is "strengthening and modernizing the nation’s health care system to provide access to high-quality care and improved health at lower cost," as stated in its fiscal year 2016 budget justification. According to a video published by CMS in October 2015, one out of every three Americans is enrolled in at least one of its programs. The organization tries to strengthen healthcare by reducing costs, increasing efficiency in spending and management, and reducing fraud. CMS is based inBaltimore,Maryland.^[1][2]

For more information, see theHistory of Medicaid and theHistory of Medicare.

History

On July 30, 1965, President Lyndon Johnson (D) signed the Social Security Amendments of 1965 into law, which establishedMedicare andMedicaid. Medicare was originally administered by the Social Security Administration, while Medicaid was administered by the Social and Rehabilitative Service Administration, both housed within the U.S. Department of Health, Education, and Welfare. In 1977, the Department of Health, Education, and Welfare was reorganized and renamed as theU.S. Department of Health and Human Services (HHS), within which the Health Care Financing Administration was established. Oversight for both Medicare and Medicaid was transferred to the Health Care Financing Administration. The agency was renamed as the Centers for Medicare & Medicaid Services in 2001. The organization is based inBaltimore, Maryland.^[3][4][5]

Structure

Administrative State
Read more about theadministrative state on Ballotpedia.

Below is an organizational chart for the Centers for Medicare and Medicaid Services (CMS). Chiquita Brooks-LaSure assumed the role of administrator in May 2021.^[6] As of February 2024, the agency's offices included the following:^[7]

Leadership

On May 25, 2021, the U.S. Senate confirmed Chiquita Brooks-LaSure as administrator of the Centers for Medicare and Medicaid Services by a vote of 55-44.^[8]

On April 3, 2025, the U.S. Senate confirmed Mehmet Oz as administrator of the Centers for Medicare and Medicaid Services by a vote of 53-45.^[9]

Budget

For the 2023 fiscal year (FY2023), the budget for the Centers for Medicare and Medicaid Services amounted to about $1.86 trillion. For fiscal year 2024, the agency requested about $1.86 trillion, approximately the same as the budget for fiscal year 2023. Clickshow on the table below to view detailed appropriations for FY2022 through FY2023.^[10][11]

Responsibilities

CMS oversees many of the major federal healthcare-related programs. This oversight is provided through over 20 different offices and divisions within the organization. Some offices track financial operations of healthcare programs, while others investigate efficiency improvements through the development or improvement of new technology.^[12]

Medicare and Medicaid

CMS is responsible for overseeingMedicare andMedicaid. In Medicare, CMS reimburses physicians directly or provides funding with private health plans that have contracted with the agency to provide healthcare to seniors. In Medicaid, the agency distributes funding to states to use in administering their individual Medicaid programs. CMS also approves or rejects applications from states to make changes to their Medicaid programs that fall outside of federal guidelines, such as requiring enrollees to pay monthly premiums. For both programs, CMS also operates fraud units that investigate fraud and pursue recovery of misspent funds.^[13]

Role of Centers for Medicare and Medicaid Services (CMS) in approving state Medicaid work requirements

See also:Arguments about work requirements for public assistance programs

The2025 budget reconciliation bill requires states to adopt a work requirement of at least 80 hours per month for able-bodied Medicaid recipients in the Affordable Care Act expansion group by January 2027. The bill allows states to apply to the Centers for Medicare and Medicaid Services (CMS) for Section 1115 waivers in order to implement Medicaid work requirements ahead of this deadline, but does not allow states to waive work requirements for Medicaid recipients. CMS is responsible for rulemaking and releasing federal guidance to the states regarding Medicaid work requirements.^[14]

Section 1115 of the Social Security Act permits the Secretary of Health and Human Services to allow states to use federal Medicaid funds under “experimental, pilot, or demonstration project(s)” that are “likely to assist in promoting the objectives of Medicaid.” CMS has approved state projects mandating work requirements for Medicaid coverage under Section 1115 in the past. Some federal courts issued rulings overturning state work requirements for Medicaid after CMS approval. CMS approved work requirements in 13 states during the first Trump administration but later withdrew those approvals under the Biden administration.^[15]

Innovation Center

The Affordable Care Act created a new office within CMS called the Center for Medicare and Medicare Innovation. The office is responsible for developing pilot programs to test the impact of new reimbursement and healthcare delivery models on Medicare and Medicaid spending.^[16]

Lyndon Johnson signing the Medicare bill, with Harry Truman, on July 30, 1965

The Innovation Center follows requirements set forth by section 1115A of theSocial Security Act that mandate the development of new payment and service delivery models for public healthcare. These models are developed by various groups within the center, and are then tested by other organizations selected by the Innovation Center. Many factors are included in the testing of new programs, such as the number of practitioners and beneficiaries included a program, demographic diversity, and alignment with previous pilot program.^[16][17]

Once a model is tested, the Innovation Center evaluates it. The quality of care and any changes in spending are among the features evaluated by the center. The center also seeks input from stakeholders such as physicians and administrators. The center holds regional meetings, hosts conference calls, and conducts webinars.^[16]

Affordable Care Act

TheAffordable Care Act, also known as the ACA or Obamacare, brought a number of changes to healthcare policy in the United States. It establishedhealth insurance exchanges, which are catalogs of health insurance plans that can be browsed by consumers. This provided CMS with new ways to design healthcare delivery and payment plans. CMS, as a federal office, has committed to the implementation of the ACA. The organization has released a number of documents discussing the Affordable Care Act and how it interacts with previous healthcare programs such as Medicaid and Medicare.^[18]

Recent news

The link below is to the most recent stories in a Google news search for the termsCenters for Medicare and Medicaid Services. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.

See also

• Healthcare policy in the United States
• Medicare
• Medicaid
• Obamacare overview

External links

• Centers for Medicare and Medicaid Services
• The CMS Innovation Center
• Healthcare.gov

Footnotes

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United States Terms Adjudication (administrative state) •Administrative judge •Administrative law •Administrative law judge •Administrative state •Arbitrary-or-capricious test •Auer deference •Barrier to entry •Bootleggers and Baptists •Chevron deference (doctrine) •Civil servant •Civil service •Code of Federal Regulations •Codify (administrative state) •Comment period •Compliance costs •Congressional Record •Coordination (administrative state) •Deference (administrative state) •Direct and indirect costs (administrative state) •Enabling statute •Ex parte communication (administrative state) •Executive agency •Federal law •Federal Register •Federalism •Final rule •Formal rulemaking •Formalism (law) •Functionalism (law) •Guidance (administrative state) •Hybrid rulemaking •Incorporation by reference •Independent federal agency •Informal rulemaking •Joint resolution of disapproval (administrative state) •Major rule •Negotiated rulemaking •Nondelegation doctrine •OIRA prompt letter •Organic statute •Pragmatism (law) •Precautionary principle •Promulgate •Proposed rule •Publication rulemaking •Regulatory budget •Regulatory capture •Regulatory dark matter •Regulatory impact analysis •Regulatory policy officer •Regulatory reform officer •Regulatory review •Rent seeking •Retrospective regulatory review •Risk assessment (administrative state) •Rulemaking •Separation of powers •Significant regulatory action •Skidmore deference •Statutory authority •Substantive law and procedural law •Sue and settle •Sunset provision •Unified Agenda of Federal Regulatory and Deregulatory Actions •United States Code •United States Statutes at Large Bibliography "Administrative Law - The 20th Century Bequeaths an 'Illegitimate Exotic' in Full and Terrifying Flower" by Stephen P. Dresch (2000) "Confronting the Administrative Threat" by Philip Hamburger and Tony Mills (2017) "Constitutionalism after the New Deal" by Cass R. Sunstein (1987) Federalist No. 23 by Alexander Hamilton (1787) "From Administrative State to Constitutional Government" by Joseph Postell (2012) "Interring the Nondelegation Doctrine" by Eric A. Posner and Adrian Vermeule (2002) "Rulemaking as Legislating" by Kathryn Watts (2015) "The Checks & Balances of the Regulatory State" by Paul R. Verkuil (2016) "The Myth of the Nondelegation Doctrine" by Keith E. Whittington and Jason Iuliano (2017) "The Progressive Origins of the Administrative State: Wilson, Goodnow, and Landis" by Ronald J. Pestritto (2007) "The Rise and Rise of the Administrative State" by Gary Lawson (1994) "The Study of Administration" by Woodrow Wilson (1887) "The Threat to Liberty" by Steven F. Hayward (2017) "Why the Modern Administrative State Is Inconsistent with the Rule of Law" by Richard A. Epstein (2008) Agencies Administrative Conference of the United States •United States Civil Service Commission •U.S. Government Accountability Office •U.S. Office of Information and Regulatory Affairs •U.S. Office of Management and Budget