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. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001.

CMS actively inspects and reports on every nursing home in the United States. This includes maintaining the 5-Star Quality Rating System.

Organization The agency carries out its responsibilities from its national headquarters located in Woodlawn, Maryland, and its 10 regional offices. It is organized around six centers to support its key functions. Numerous other offices throughout the agency support these centers.

The centers:

Center for Medicare (CM) Center for Medicaid and CHIP Services (CMCS) Center for Medicare and Medicaid Innovation (CMMI, a.k.a. the CMS Innovation Center) Center for Consumer Information and Insurance Oversight (CCIIO) Center for Program Integrity (CPI) Center for Clinical Standards and Quality (CCSQ)

The regions:

Region Office Jurisdiction I Boston, Massachusetts Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont II New York, New York New York, New Jersey, U.S. Virgin Islands, and Puerto Rico III Philadelphia, Pennsylvania Delaware, Maryland, Pennsylvania, Virginia, West Virginia, and the District of Columbia IV Atlanta, Georgia Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee V Chicago, Illinois Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin VI Dallas, Texas Arkansas, Louisiana, New Mexico, Oklahoma, and Texas VII Kansas City, Missouri Iowa, Kansas, Missouri, and Nebraska VIII Denver, Colorado Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming IX San Francisco, California Arizona, California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands X Seattle, Washington Alaska, Idaho, Oregon, and Washington

Workforce CMS employs over 6,000 people, of whom about 4,000 are located at its headquarters in Woodlawn, Maryland. The remaining employees are located in the Hubert H. Humphrey Building in Washington, D.C., the 10 regional offices listed below, and in various field offices located throughout the United States.

The head of CMS is the administrator of the Centers for Medicare & Medicaid Services. The position is appointed by the president and confirmed by the Senate. On May 27, 2021, Chiquita Brooks-LaSure was sworn in as administrator, the first black woman to serve in the role.

History Originally, the name "Medicare" in the United States referred to a program providing medical care for families of people serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956.Robinson, P. I. (1957). Medicare: Uniformed Services Program for Dependents. Social Security Bulletin, 20(7), 9–16. President Dwight D. Eisenhower held the first White House Conference on Aging in January 1961, in which creating a health care program for social security beneficiaries was proposed.Tibbits C. "The 1961 White House Conference on Aging: it's rationale, objectives, and procedures". J Am Geriatr Soc. 1960 May. 8:373–77Mcnamara PAT, Dirksen EM, Church F, Muskie ES. The 1961 White House Conference on Aging: basic policy statements and recommendations / prepared for the Special Committee on Aging, United States Senate 87th Congress, 1st Session, Committee Print, May 15, 1961.

President Lyndon B. Johnson signed the Social Security Amendments on July 30, 1965, establishing both Medicare and Medicaid. Arthur E. Hess, a deputy commissioner of the Social Security Administration, was named as first director of the Bureau of Health Insurance in 1965, placing him as the first executive in charge of the Medicare program. At the time, the program provided health insurance to 19 million Americans. The Social Security Administration (SSA) became responsible for the administration of Medicare and the Social and Rehabilitation Service (SRS) became responsible for the administration of Medicaid. Both agencies were organized under what was then known as the Department of Health, Education, and Welfare (HEW), in 1965. Since then, HEW, has been reorganized as the Department of Health and Human Services (HHS) in 1980. This consequently brought Medicare and Medicaid under the jurisdiction of the HHS.

In March 1977, the Health Care Financing Administration (HCFA) was established under HEW. HCFA became responsible for the coordination of Medicare and Medicaid. The responsibility for enrolling beneficiaries into Medicare and processing premium payments remained with SSA.

HCFA was renamed the Centers for Medicare & Medicaid Services on July 1, 2001. This was later codified in law by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Title IX, § 900(e).

In 2013, a report by the inspector general found that CMS had paid $23 million in benefits to deceased beneficiaries in 2011.

In April 2014, CMS released raw claims data from 2012 that gave a look into what types of doctors billed Medicare the most.

In January 2018, CMS released guidelines for states to use to require Medicaid beneficiaries to continue receiving coverage. These guidelines came in response to then-President Trump's announcement that he would allow states to impose work requirements in Medicaid. In October, CMS reported a data breach of 75,000 people's personal data due to a hack.

In February 2018, CMS removed a notice from its website that informed insurance companies they were not allowed to charge physicians a fee when the companies paid the doctors for their work. This has resulted in doctors being charged up to a 5% fee on their compensation, adding up to billions of dollars annually.

In January 2021, CMS passed a rule that would cover "breakthrough technology" for four years after they received FDA approval. In September 2021, CMS submitted a proposal to repeal the rule based on safety concerns.

On September 19, 2023, the Subcommittee on Health held a hearing titled "Examining Policies to Improve Seniors’ Access to Innovative Drugs, Medical Devices, and Technology." Dora Hughes, the acting director of the Center for Clinical Standards and Quality at the U.S. Centers for Medicare and Medicaid Services (CMS), defended the proposed Transitional Coverage for Emerging Technologies (TCET) pathway, which aims to restrict coverage for breakthrough medical devices to five reviews a year. Some lawmakers and medtech trade groups called for expanding the pathway to include diagnostics. Various other legislative proposals were discussed during the hearing, including bills related to Medicare coverage, drug pricing, and transparency in healthcare.

WISeR Model (AI-assisted prior authorization in Original Medicare) On January 1, 2026, CMS launched the Wasteful and Inappropriate Service Reduction (WISeR) Model through the Center for Medicare and Medicaid Innovation, introducing prior authorization for selected traditional Medicare Part B services in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. The model uses artificial intelligence to support medical necessity reviews, although all adverse determinations are made by licensed clinicians rather than automated systems. The model drew opposition from the American Hospital Association, which requested a six-month implementation delay, and prompted legislation introduced in late 2025 to repeal it.

List of administrators ImageNameTook officeLeft officePresident served under1Arthur E. Hess19651967Lyndon B. Johnson2Thomas M. Tierney19671978Lyndon B. JohnsonRichard NixonGerald FordJimmy Carter3Robert DerzonJune 1977November 1978Jimmy Carter4 Leonard SchaefferNovember 1978June 19805Howard N. NewmanJuly 1980January 19816Carolyne DavisMarch 1981August 1985Ronald Reagan7William L. RoperMay 1986February 1989Ronald ReaganGeorge H. W. Bush8Gail WilenskyFebruary 1990March 1992George H. W. Bush9Bruce VladeckMay 1993September 1997Bill Clinton10Nancy-Ann DeParleNovember 1997September 29, 200011Thomas A. ScullyMay 2001December 3, 2003George W. Bush12Mark McClellanMarch 25, 2004October 14, 2006ActingKerry WeemsOctober 14, 2006January 20, 2009ActingCharlene FrizzerJanuary 20, 2009July 7, 2010Barack Obama13Donald BerwickJuly 7, 2010December 2, 201114Marilyn TavennerDecember 2, 2011March 18, 2015ActingAndy SlavittMarch 18, 2015January 20, 201715Seema VermaMarch 14, 2017January 20, 2021Donald TrumpActingElizabeth RichterJanuary 20, 2021May 27, 2021Joe Biden16Chiquita Brooks-LaSureMay 27, 2021January 20, 2025ActingJeff WuJanuary 20, 2025January 31, 2025Donald TrumpActing Stephanie CarltonJanuary 31, 2025April 8, 202517Mehmet OzApril 8, 2025Incumbent

See also Zone Program Integrity Contractor

References

Robinson, P. I. (July 1957). "Medicare: Uniformed Services Program for Dependents". Social Security Bulletin, 20(7), 9–16.

External links

Centers for Medicare and Medicaid Services in the Federal Register Centers for Medicare & Medicaid Services in the Code of Federal Regulations Centers for Medicare & Medicaid Services reports and recommendations from the Government Accountability Office Grants to States for Medicaid account on USAspending.gov Centers for Medicare and Medicaid Innovation account on USAspending.gov State Grants and Demonstration account on USAspending.gov Centers for Medicare and Medicaid Services apportionments on OpenOMB GitHub Repositories GitHub Repositories for Digital Service at CMS