The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS). It administers the nation’s major healthcare programs including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.
Functions
- Medicare: CMS manages Medicare, a federal program providing health coverage if you are 65 or older or have a severe disability, no matter your income.
- Medicaid: CMS administers Medicaid, a state and federal program that provides health coverage if you have a very low income.
- Children’s Health Insurance Program (CHIP): Oversees CHIP, which provides health coverage to eligible children, through both Medicaid and separate CHIP programs.
- Health Insurance Marketplace: CMS is responsible for the oversight of the Health Insurance Marketplace, where individuals, families, and small businesses can find, compare, and buy health insurance.
Historical Context
Originally known as the Health Care Financing Administration (HCFA), CMS was established in 1977 to oversee the Medicare and Medicaid programs, which were previously managed by the Social Security Administration and various state agencies. The agency was renamed in 2001 to more accurately reflect its broader scope of operations.
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Regulation and Compliance
CMS also plays a crucial role in the licensing of federally qualified Health Maintenance Organizations (HMOs) and ensures compliance with relevant healthcare laws and regulations, including the Affordable Care Act (ACA). It sets standards for healthcare providers and is actively involved in combating healthcare fraud and abuse.
