DEFINITION of 'U.S. Centers for Medicare and Medicaid Services (CMS) '

The federal government agency that administers the nation’s major healthcare programs: Medicare, Medicaid, the Children’s Health Insurance Programs (CHIP) and the state and federal health insurance marketplaces. CMS also collects and analyzes data and produces research reports on these programs and works to eliminate instances of fraud and abuse within the healthcare system. Further, CMS is responsible for managing the administrative simplification standards of the Health Insurance Portability and Accountability Act (HIPPA) and for ensuring quality standards in clinical laboratories under the Clinical Laboratory Improvement Amendments.

BREAKING DOWN 'U.S. Centers for Medicare and Medicaid Services (CMS) '

CMS is an agency within the federal Department of Health and Human Services. The agency’s goal is to provide “a high quality healthcare system that ensures better care, access to coverage and improved health.” The agency has offices at its headquarters in Maryland and in several cities throughout the United States, including Boston, Kansas City, San Francisco and Atlanta, strategically positioned to serve each region.

President Lyndon B. Johnson created Medicare and Medicaid in 1965. Initially, these programs were managed by other agencies. Medicare is a taxpayer-funded entitlement program for seniors 65 and older. It consists of four parts, A, B, C and D (created in 2003 by President George W. Bush), that pay for hospital stays and nursing home care, preventive healthcare and screenings, doctor visits, durable medical equipment, home healthcare, outpatient services, hospice care and prescription drugs. Medicare enrollees share costs with taxpayers through premiums and out-of-pocket expenditures. Read about How Much Medicare and Medicaid Costs Americans.

Medicaid is a federal and state program that helps with medical expenses for low-income patients. It is possible to be eligible for both Medicare and Medicaid if you are a senior with limited financial resources. The Children's Health Insurance Program provides health coverage for children whose families have limited financial resources but aren’t poor enough to qualify for Medicaid. Through its Center for Consumer Information & Insurance Oversight, CMS plays a role in the federal and state health insurance marketplaces by helping to implement the Affordable Care Act’s laws about private health insurance and providing educational materials to the public.

 

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