Alyssa Lane
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. CMS provides health coverage to more than 100 million people through these programs and seeks to strengthen and modernize the nation's healthcare system.
| Characteristics | Values |
|---|---|
| Full Form | Centers for Medicare & Medicaid Services |
| Type of Agency | Federal Agency |
| Parent Department | Department of Health and Human Services |
| Headquarters | Woodlawn, Maryland |
| Regional Offices | 10 throughout the United States |
| Functions | Administers major healthcare programs, including Medicare, Medicaid, and the Children's Health Insurance Program |
| Collects and analyzes data, produces research reports, and works to eliminate fraud and abuse | |
| Provides health coverage to more than 100 million people | |
| Works to improve the healthcare system by providing access to high-quality, affordable care | |
| Oversees quality in clinical laboratories and long-term care facilities | |
| Provides oversight of health insurance exchanges and marketplaces | |
| Awards more than one billion dollars in federal financial assistance |
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What You'll Learn
- CMS is a federal agency that administers major healthcare programs
- CMS provides health coverage to over 100 million people
- CMS collects and analyses data, producing research reports
- CMS works to eliminate fraud and abuse in the healthcare system
- CMS awards over $1 billion in federal financial assistance
CMS is a federal agency that administers major healthcare programs
The Centers for Medicare and Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers major healthcare programs. CMS is responsible for overseeing the management of Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).
CMS plays a crucial role in ensuring access to healthcare for over 100 million people in the United States. It works in partnership with state governments to administer Medicaid and CHIP, providing health coverage for children and low-income individuals. The agency also administers Medicare, which offers health insurance to older adults and people with disabilities.
In addition to these core programs, CMS has a range of other responsibilities. These include administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which aim to streamline healthcare transactions and protect patient privacy. CMS also sets quality standards for long-term care facilities, clinical laboratories, and health insurance marketplaces.
CMS collects and analyzes data, conducts research, and works to prevent fraud and abuse within the healthcare system. The agency strives to strengthen and modernize healthcare, improve access to quality care, and lower costs for Americans. CMS's work extends beyond traditional healthcare programs, as they also play a role in disaster response and public health emergencies.
The head of CMS is the administrator, appointed by the president and confirmed by the Senate. The agency has its headquarters in Woodlawn, Maryland, with regional offices across the United States. CMS's work is guided by a commitment to effective stewardship of public trust and the security of personal information entrusted to them by millions of Americans.
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CMS provides health coverage to over 100 million people
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS). CMS administers the nation's major healthcare programs, including Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace.
CMS provides health coverage to more than 100 million people through these programs. It is committed to strengthening and modernizing the nation's healthcare system, improving access to high-quality care, and lowering costs. CMS has taken steps to ensure that Americans from all walks of life can access healthcare services. For instance, in 2021, CMS passed a rule to cover "breakthrough technology" for four years after receiving FDA approval.
Medicare is a federal health insurance program for people aged 65 and over and some younger people with disabilities. It provides health coverage for services such as inpatient hospital stays, doctor visits, and prescription drugs. On the other hand, Medicaid is a joint federal-state program that provides health coverage to low-income individuals and families who meet certain eligibility requirements. It covers a wide range of health services, including hospital stays, doctor visits, and long-term care.
CHIP is another crucial program administered by CMS, providing health coverage to children in families who do not qualify for Medicaid but cannot afford private insurance. This program ensures that children have access to the healthcare services they need to grow and thrive. Additionally, CMS plays a role in the federal and state health insurance marketplaces, helping to implement affordable coverage options for individuals and families.
CMS also has other responsibilities beyond these core programs. It oversees quality standards in clinical laboratories and long-term care facilities, works to simplify administrative processes in healthcare, and collects and analyzes data to inform healthcare policy and improve the efficiency of the healthcare system.
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CMS collects and analyses data, producing research reports
CMS, or the Centers for Medicare & Medicaid Services, is a federal agency within the United States Department of Health and Human Services (HHS). It administers the Medicare program and works with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. CMS provides health coverage to over 100 million people through these programs and the Health Insurance Marketplace.
The CMS Qualified Entity (QE) Program, or the Medicare Data Sharing for Performance Measurement Program, enables organisations to receive Medicare claims data under Parts A, B, and D for evaluating provider performance. These organisations are required to use the data to generate and publicly disseminate CMS-approved reports on provider performance. CMS also produces de-identified public data products such as public use files, data tables, dashboards, and mapping tools, which are freely available on its open data websites.
CMS's research efforts extend to the evaluation of its Innovation Center Models, with best practices and lessons learned from evaluation reports informing subsequent model tests. The agency is committed to increasing access to its Medicare claims data by releasing de-identified data files for public use, available to researchers at no cost. CMS also recognises the importance of transparency in its processes and strives to make CMS-supported research and data more accessible to the public.
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CMS works to eliminate fraud and abuse in the healthcare system
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program. It works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. CMS provides health coverage to more than 100 million people through these programs.
CMS has been working to eliminate fraud and abuse in the healthcare system. Since its inception in 1997, the Health Care Fraud and Abuse Control (HCFAC) Program has been at the forefront of the fight against healthcare fraud, waste, and abuse. CMS has expanded its capacity to fight fraud and abuse by using powerful, new anti-fraud tools to protect Medicare and Medicaid. In Fiscal Year (FY) 2016, CMS continued its use of the Affordable Care Act authority to suspend Medicare payments to providers during an investigation of a credible allegation of fraud. CMS also has the authority to suspend Medicare payments if reliable information about overpayment is available. During FY 2016, there were 508 payment suspensions, with 291 new suspensions imposed that year.
Under the Medicaid/CHIP Financial Management project, funding specialists, including accountants and financial analysts, worked to improve CMS’ financial oversight of the Medicaid Program and CHIP. In FY 2016, CMS removed an estimated $608 million in questionable Medicaid costs. An additional $666 million in questionable reimbursement was averted due to the funding specialists' preventive work with states to promote proper state Medicaid financing.
CMS also utilizes the Healthcare Fraud Prevention Partnership, which has helped build stronger relationships between the government and the private sector to help protect all consumers. In FY 2016, the government recovered over $3.3 billion as a result of healthcare fraud judgments, settlements, and additional administrative impositions in healthcare fraud cases and proceedings.
In June 2025, the National Health Care Fraud Takedown resulted in 324 defendants charged in connection with over $14.6 billion in alleged fraud. As part of the Takedown, CMS prevented over $4 billion from being paid in response to false and fraudulent claims and suspended or revoked the billing privileges of 205 providers.
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CMS awards over $1 billion in federal financial assistance
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS). CMS provides health coverage to over 100 million people through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace. The agency works to improve the quality, equity, and outcomes of the healthcare system. CMS awards more than $1 billion in federal financial assistance to promote advancing health equity, expanding coverage, and improving health outcomes for the public. These awards are typically in the form of grants and cooperative agreements to states and local governments, nonprofit organizations, institutions of higher education, and for-profits.
On August 27, 2021, CMS announced $80 million in funding for 60 Navigator programs serving 30 Federally-Facitated Marketplace (FFM) states for the 2022 plan year. This funding was intended to help consumers understand their plan choices and complete applications for financial assistance. The total funding for 2021 was significantly higher than in previous years, with $10 million awarded annually during the Trump Administration and $63 million in the final year of the Obama Administration.
In addition to its financial assistance programs, CMS has other responsibilities, including administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and quality standards in long-term care facilities through its survey and certification process. CMS also oversees HealthCare.gov and the Medicaid Information Technology Architecture (MITA) pages. The agency is headed by an administrator appointed by the president and confirmed by the Senate. As of May 27, 2021, Chiquita Brooks-LaSure serves as the administrator and is the first black woman to hold this position.
CMS has faced some challenges in recent years, including a data breach in October 2018 that exposed the personal data of 75,000 people. In 2013, a report found that CMS had paid $23 million in benefits to deceased beneficiaries in 2011. However, the agency continues to work towards strengthening and modernizing the nation's healthcare system, providing access to high-quality, affordable care for millions of Americans.
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Frequently asked questions
CMS stands for Centers for Medicare & Medicaid Services.
CMS is a federal agency within the United States Department of Health and Human Services (HHS) that administers the nation's major healthcare programs.
CMS oversees programs, including Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the state and federal health insurance marketplaces. CMS collects and analyzes data, produces research reports, and works to eliminate instances of fraud and abuse within the healthcare system.
CMS was previously known as the Health Care Financing Administration (HCFA) until July 1, 2001. On May 27, 2021, Chiquita Brooks-LaSure was sworn in as administrator, the first black woman to serve in the role.
