The Centers for Medicare & Medicaid Services
Summary
CMS runs Medicare and Medicaid on a $5.0 billion FY2026 operating budget and 4,689 federal employees -- while Medicare alone stayed on GAO's High-Risk List with an estimated $56.7 billion in improper payments in FY2025, more than eleven times the agency's own budget to run itself.
What is this organization?
What does it do?
's Medicare Administrative Contractors process more than 1 billion Original Medicare claims a year⧉, and independent contractors decided 203,857 Medicare appeal reconsiderations in FY2025⧉ alone. State agencies funds completed 97,345 health-and-safety surveys⧉ of nursing homes, hospitals, and other providers in FY2024, results published on Medicare's Care Compare site. By its own FY2027 projection, CMS's programs will cover 164 million Americans⧉ -- Medicare, Medicaid, , and Marketplace plans combined.
What does it cost to run — money and people?
Congress enacted $5.0 billion in FY2026 budget authority⧉ for 's own Program Management account -- separate from the more than $1 trillion in Medicare benefit payments⧉ projects for calendar year 2027 -- rising to $8.3 billion including user-fee collections, and supporting 4,689 Program Management FTEs, up from 4,447 in FY2025. Against the Census Bureau's 341.8 million U.S. residents⧉ as of July 2025, that works out to about $14.63 per person.
View data as table
| Program Administration | 3,284.6 | policy, systems, beneficiary/provider operations |
|---|---|---|
| Medicare Operations General Provision | 455 | one-time FY2026 addition |
| State Survey & Certification | 397.3 | funds state inspections of providers |
Why is it good for society?
co-funds the government's Health Care Fraud and Abuse Control program, whose law-enforcement partnerships returned $2.80 for every $1.00 invested from 2021 to 2023⧉. The counterfactual is the number itself puts on the alternative: Medicare has stayed on GAO's High-Risk List for years, with an estimated $56.7 billion in improper payments⧉ across Original Medicare, Part C, and Part D in FY2025 alone -- more than eleven times 's own FY2026 operating budget. Fraud enforcement and program-integrity reviews are the mechanism that keeps that number from growing unchecked.
- 's FY2026 operating budget ($5.0 billion, 4,689 FTEs) works out to about $14.63 per U.S. resident -- the machinery that administers Medicare, Medicaid, and , not the benefit payments themselves, which run into the trillions.
- Medicare's own improper-payment estimate ($56.7 billion in FY2025) is more than eleven times 's entire FY2026 operating budget -- the scale of the fraud-and-error problem 's program-integrity work is set against, with a stated $2.80-per-$1.00 return on its fraud-enforcement partnerships.
Your handles.* Disagree with a Medicare coverage or payment decision? File a Medicare Redetermination Request (Form CMS-20027) with your Medicare Administrative Contractor within 120 days. Before choosing a nursing home or hospital, check its health-and-safety inspection history on Medicare's Care Compare. To comment on a proposed rule before it's finalized, see CMS Rulemaking for open comment periods.
Sources(3) ▾
- U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Centers for Medicare & Medicaid Services FY 2027 Justification of Estimates for Appropriations Committees (2026-03-01) — 's own FY2027 congressional budget justification -- the Mandatory & Discretionary All-Purpose Table (p.6-7) gives the FY2025 Final / FY2026 Enacted / FY2027 President's Budget summary of 's own Program Management budget authority, total program level, and staffing this entry's KPIs and chart come from. Also the source for 's statutory identity (p.1, p.16), Medicare/Medicaid/ program descriptions, workload figures (claims processed, survey counts, QIC appeal volume), and the Medicare Integrity Program's fraud-risk and improper-payment figures (p.82). cms.gov · original document
- U.S. Department of Health and Human Services, Office of the Secretary / Government Publishing Office (govinfo.gov), Centers for Medicare & Medicaid Services; Statement of Organization, Functions and Delegations of Authority; Reorganization Order (66 FR 35437) (2001-07-05) — The Federal Register reorganization order itself, signed by Secretary Tommy Thompson on June 29, 2001, retitling Part F of 's Statement of Organization -- the Health Care Financing Administration -- as the Centers for Medicare & Medicaid Services. The order's own text dates HCFA's creation to a Part F amendment at 46 FR 13262-63, March 9, 1977, and is the strongest available primary source for both the 1977 founding and the 2001 rename. govinfo.gov · original document
- U.S. Census Bureau, U.S. Population Growth Slows Due to Historic Decline in Net International Migration (Vintage 2025 national population estimate) (2026-01-27) — The source for the July 1, 2025 U.S. resident population estimate (341.8 million) used as the per-resident KPI's denominator. Same document the good-citizen-hhs-oig and good-citizen-dod-oig entries already rely on. census.gov · original document
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is the operating division of the Department of Health and Human Services⧉ that runs the federal government's two largest health programs. Medicare and Medicaid were both authorized in 1965⧉ under Titles XVIII and XIX of the Social Security Act; followed under Title XXI. The agency itself began inside as the Health Care Financing Administration in 1977. On June 29, 2001, HHS Secretary Tommy Thompson signed a reorganization order⧉ retitling it the Centers for Medicare & Medicaid Services.