Centers for Medicare and Medicaid Services
| Centers for Medicare and Medicaid Services | |
| Administrator: | Chiquita Brooks-LaSure |
| Annual budget: | $1.86 trillion (FY 2023) |
| Year created: | 1977 |
| Official website: | Office website |
The Centers for Medicare and Medicaid Services (CMS) manages funding for public healthcare programs such as Medicaid, Medicare, the Children's Health Insurance Program (CHIP), and the health insurance exchanges created by the Affordable 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 in Baltimore, Maryland.[1][2]
- For more information, see the History of Medicaid and the History of Medicare.
History
On July 30, 1965, President Lyndon Johnson (D) signed the Social Security Amendments of 1965 into law, which established Medicare and Medicaid. 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 the U.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 in Baltimore, Maryland.[3][4][5]
Structure
| Administrative State |
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| Read more about the administrative 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]
- Office of Burden Reduction & Health Informatics
- Office of Program Operations & Local Engagement
- Office of Enterprise Data and Analytics
- Office of Equal Opportunity and Civil Rights
- Office of Communications
- Office of Legislation
- Federal Coordinated Healthcare Office
- Office of Minority Health
- Office of the Actuary
- Office of Strategic Operations and Regulatory Affairs
- Office of Information Technology
- Office of Acquisition and Grants Management
- Offices of Hearing and Inquiries
- Office of Financial Management
- Office of Strategy, Performance, and Results
- Office of Security, Facilities, and Logistics Operations
- Office of Human Capital
- Center for Clinical Standards and Quality
- Office of Clinician Engagement
- Center for Medicare and Medicaid Innovation
- Center for Medicare
- Center for Medicaid and CHIP Services
- Center for Program Integrity
- Center for Consumer Information and Insurance Oversight
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]
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. Click show on the table below to view detailed appropriations for FY2022 through FY2023.[9][10]
| Centers for Medicare and Medicaid Services budget, FY2022 - FY 2023 | ||||
|---|---|---|---|---|
| Program | FY2022 | FY2023 | ||
| Program Management | $4,024,744,000 | $4,124,744,000 | ||
| HCFAC | $873,000,000 | $893,000,000 | ||
| Grants to States for Medcaid | $517,398,421,000 | $533,079,108,000 | ||
| Payments to Health Care Trust Funds | $497,862,000,000 | $548,130,000,000 | ||
| Total | $1,020,158,164,000 | $1,086,226,854,000 | ||
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.[11]
Medicare and Medicaid
CMS is responsible for overseeing Medicare and Medicaid. 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.[12]
Role of Centers for Medicare and Medicaid Services (CMS) in approving state Medicaid work requirements
Under Section 1115 of the Social Security Act, the Secretary of Health and Human Services may 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.” The Centers for Medicare and Medicaid Services (CMS) may approve state projects mandating work requirements for Medicaid coverage, but some federal courts have issued rulings overturning state work requirements for Medicaid after CMS approval. CMS approved work requirements in 13 states during the Trump administration but later withdrew those approvals under the Biden administration.[13]
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.[14]
The Innovation Center follows requirements set forth by section 1115A of the Social 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.[14][15]
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.[14]
Affordable Care Act
The Affordable Care Act, also known as the ACA or Obamacare, brought a number of changes to healthcare policy in the United States. It established health 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.[16]
Recent news
The link below is to the most recent stories in a Google news search for the terms Centers for Medicare and Medicaid Services. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.
See also
External links
Footnotes
- ↑ Centers for Medicare and Medicaid Services, "Justification of Estimates for Appropriations Committees," accessed January 5, 2016
- ↑ Youtube, "Getting to know CMS - Short version," accessed October 16, 2015
- ↑ The New Yorker, "How Medicare Was Made," February 15, 2015
- ↑ Centers for Medicare and Medicaid Services, "CMS History Page Quiz," August 10, 2017
- ↑ Centers for Medicare and Medicaid Services, "Why is CMS in Baltimore?" accessed August 10, 2017
- ↑ U.S. Department of Health & Human Services, "Statement on the Swearing-In of Chiquita Brooks-LaSure as Administrator of the Centers for Medicare and Medicaid Services," May 27, 2021
- ↑ Centers for Medicare and Medicaid Services, "Organizational Chart," accessed February 21, 2024
- ↑ Home Health Care News, "Senate Narrowly Confirms Chiquita Brooks-LaSure as Next CMS Administrator," May 25, 2021
- ↑ U.S. Department of Health and Human Services, "HHS FY2016 Budget in Brief: Centers for Medicare & Medicaid Services (CMS)," accessed August 10, 2017
- ↑ U.S. Department of Health and Human Services, "HHS FY 2017 Budget in Brief - CMS - Overview," accessed August 10, 2017
- ↑ Centers for Medicare and Medicaid Services, "CMS Leadership," accessed October 16, 2015
- ↑ Centers for Medicare and Medicaid Services, "Fraud Prevention Toolkit," accessed September 1, 2017
- ↑ KFF, Overview of Medicaid work requirements, accessed April 11, 2023
- ↑ 14.0 14.1 14.2 Centers for Medicare and Medicaid Services, "About the CMS Innovation Center," accessed September 1, 2017
- ↑ Centers for Medicare and Medicaid Services, "Model Design Factors," accessed October 19, 2015
- ↑ The Centers for Medicare and Medicaid Services, "History," accessed October 19, 2015
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