The Centers for Medicare and Medicaid Services began in Baltimore, Maryland

The Centers for Medicare and Medicaid Services (CMS) was founded in 1965 as the Health Care Financing Administration (HCFA). It was created the same year that Medicare and Medicaid became law, and it was placed in Baltimore because that city was chosen as the headquarters location by the federal government. The agency's job from the start was to run both programs — Medicare for people 65 and older, and Medicaid for low-income individuals and families.

Baltimore remains the home of CMS headquarters today. The agency has grown from managing two new programs in 1965 to overseeing healthcare coverage for more than 150 million Americans. That includes Medicare beneficiaries, Medicaid recipients, and people covered through the Children's Health Insurance Program (CHIP).

Key Takeaways

  • CMS was founded in Baltimore, Maryland in 1965 as the Health Care Financing Administration, the same year Medicare and Medicaid became law.
  • The agency was created specifically to manage and oversee both the Medicare and Medicaid programs from their start.
  • CMS is part of the U.S. Department of Health and Human Services and remains headquartered in Baltimore.
  • The name changed from HCFA to Centers for Medicare and Medicaid Services in 2001 to better reflect its expanded role.

Why Baltimore was chosen as the headquarters

The federal government selected Baltimore as the location for the new agency in 1965 for practical reasons related to infrastructure and workforce. Baltimore had the space, office buildings, and existing federal presence needed to house a large new bureaucracy. The city was also positioned on the East Coast, which made it accessible to Congress and other federal agencies in Washington, D.C.

The decision to place CMS in Baltimore rather than Washington itself was deliberate — it kept the operational headquarters separate from the policy-making center. This structure allowed the agency to focus on the day-to-day work of processing claims and managing the programs without being directly embedded in the political machinery of the capital.

How the agency's name and role changed over time

When it started in 1965, the agency was called the Health Care Financing Administration (HCFA). For 36 years, that was its official name. In 2001, the agency was renamed the Centers for Medicare and Medicaid Services to better reflect that it managed more than just financing — it oversaw the actual delivery and quality of care across multiple programs.

The name change also signaled a shift in how the agency saw its mission. Beyond paying claims, CMS began taking on larger roles in setting quality standards, fighting fraud, and managing new programs. The new name made that broader responsibility clearer to the public and to healthcare providers.

What CMS does today

CMS now oversees three major programs: Medicare (for people 65 and older and some younger people with disabilities), Medicaid (for low-income individuals and families), and CHIP (for children in families that earn too much for Medicaid but not enough to afford private insurance). The agency also regulates hospitals, nursing homes, dialysis centers, and other healthcare facilities to make sure they meet federal standards.

The agency processes millions of claims every year and sets the rules for how healthcare providers bill for services. CMS also runs quality reporting programs that let patients see how hospitals and doctors perform on measures like infection rates and patient satisfaction. These public reports help seniors and other beneficiaries make informed choices about where to receive care.

How CMS connects to your Medicare coverage

If you receive Medicare, CMS is the federal agency that sets the rules for your coverage. CMS decides which services Medicare will pay for, how much it will pay, and what beneficiaries have to pay out of pocket. The agency also oversees the private insurance companies (called Medicare Advantage plans and Medigap insurers) that offer coverage options to Medicare beneficiaries.

When you have a question about what Medicare covers or why a claim was denied, you are ultimately dealing with rules and decisions made by CMS. The agency publishes coverage decisions on its website, and you can contact CMS directly if you need to understand why something is or is not covered under your plan.

The relationship between CMS and the Department of Health and Human Services

CMS is not an independent agency — it is a division of the U.S. Department of Health and Human Services (HHS). The Secretary of Health and Human Services is the cabinet-level official responsible for CMS, and the CMS Administrator reports to that Secretary. This structure means that Medicare and Medicaid policy is set within the broader context of federal health policy.

The HHS connection also means that CMS works alongside other federal health agencies like the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). When there are public health emergencies or changes to healthcare law, CMS coordinates with these other agencies to implement new rules and coverage decisions.

Frequently Asked Questions

Is CMS the same as Medicare?

No. CMS is the federal agency that runs Medicare, but they are not the same thing. Medicare is the health insurance program for people 65 and older. CMS is the government agency that manages it, sets the rules, and processes the claims. CMS also runs Medicaid and CHIP, which are separate programs.

Can I contact CMS directly with questions about my Medicare coverage?

Yes. CMS has a phone line and website where you can ask questions about Medicare coverage and policy. However, for questions about your specific claim or bill, you may need to contact your Medicare plan or the provider's billing office first. CMS can help if you disagree with a coverage decision or need to understand a rule.

Why does CMS regulate hospitals and nursing homes?

CMS regulates these facilities because Medicare and Medicaid pay for much of the care they provide. To protect beneficiaries and make sure federal money is spent properly, CMS sets safety and quality standards that hospitals, nursing homes, and other providers must meet to receive payment from these programs.

Has CMS always been in Baltimore?

Yes. CMS has been headquartered in Baltimore since it was founded in 1965. The agency has grown and opened regional offices in other cities, but the main headquarters and administrative center remain in Baltimore, Maryland.