Here’s how CMS can affect your life, and why you should pay attention to who’s running it.
The Centers for Medicaid and Medicare Services (CMS) was founded in 1977. The person who runs it — the CMS administrator — is in charge of access to publicly funded health care services and health care coverage in America.
How CMS Fits in the Federal Government
CMS is a federal agency within the U.S. Department of Health and Human Services (HHS).
CMS manages and pays for health care.
In fact, CMS pays for more health care than any other organization in the United States.
What CMS Does
About 140 million Americans rely on CMS to access health care. CMS:
Oversees Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).
Manages health care coverage through the Affordable Care Act (ACA), including its health insurance exchange marketplace on HealthCare.gov.
Helps oversee health care privacy and certain nationwide provider quality standards.
Helps ensure beneficiaries continue to receive health care even in the face of disasters and public health emergencies. CMS helps state and tribal leaders, health care providers, and other federal offices get the information they need to respond to emergencies.
Key CMS Programs
CMS plays a direct role in many people’s lives because it manages the programs below. CMS can strengthen and support these initiatives — or put up barriers to care.
CMS runs Medicaid, which helps provide health insurance to people with low incomes.
Medicaid is a major insurer for sexual and reproductive health care. Medicaid pays for 75% of all U.S. publicly funded family planning services.
One out of every five American women of reproductive age uses Medicaid to access primary and reproductive health care, including cancer screenings, birth control, STD testing and treatment, and maternity care.
For 42% of people who gave birth in 2019, Medicaid coverage paid for essential pregnancy care — including prenatal and delivery care.
Medicare coverage is available to people 65 or older, people with disabilities, and people with end-stage renal disease requiring dialysis or kidney transplant.
Medicare and Medicaid are the two programs that provide the most health care to women of all ages.
Affordable Care Act
CMS also manages parts of the ACA, including its health insurance marketplace. The marketplace is a one-stop-shop for people to enroll in ACA-compliant health insurance plans. The ACA also prohibits discrimination in health coverage and requires insurance plans to cover pregnancy care and birth control without a copay.
CMS gives health insurance and preventive care to nearly 10 million uninsured children through the Children's Health Insurance Program (CHIP).
The CMS Administrator’s Role
The leading CMS official or the “administrator,” runs the operation of key parts of the nation’s health care system,including the programs mentioned above. The CMS administrator — along with the secretary of the U.S. Department of Health and HumanServices (HHS) — makes long-term health care policy decisions for the entire country.