What Does the Administrator of the Centers for Medicare & Medicaid Services Do?
Key Takeaways
- President-elect Donald Trump has nominated Dr. Mehmet Oz as the new head of the Centers for Medicare & Medicaid Services (CMS), succeeding Chiquita Brooks-LaSure.
- The administrator of CMS oversees Medicare, Medicaid, and the Marketplace, sets policies, ensures compliance, and directs a budget that accounted for nearly $1.5 trillion in federal spending in 2023.
- Dr. Oz has shown support for expanding Medicare Advantage plans, potentially increasing their benefits and reducing restrictions, though such expansions could raise long-term budget concerns.
President-elect Donald Trump has chosen Dr. Mehmet Oz as the new head of the Centers for Medicare & Medicaid Services (CMS). Dr. Oz is famous for his long-running television show The Dr. Oz Show. If confirmed, he will replace the current administrator Chiquita Brooks-LaSure, who has led the CMS since 2021.
As Dr. Oz prepares to step into this new role, many are curious about how his approach will shape the future of an agency that oversees healthcare for over 160 million Americans.
The Role of the CMS in Medicare
The Centers for Medicare and Medicaid Services (CMS) was founded in 1977 to manage the Medicare and Medicaid programs. Today, the CMS is responsible for Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.
The CMS directly impacts millions, including the nearly 68 million Americans who rely on Medicare for their healthcare needs. Within CMS, the Center for Medicare ensures that the Medicare program remains efficient and responsive to beneficiaries’ needs.
Medicare provides healthcare to those 65 years old and older and those eligible for coverage due to a disability. This includes overseeing the following Medicare parts:
- Part A (hospital coverage)
- Part B (medical coverage)
- Part C (Medicare Advantage plans)
- Part D (prescription drug coverage)
- Medicare Supplement Insurance (also known as Medigap)
The CMS works with Medicaid state officials to provide health insurance to low-income families and individuals. By managing Medicare and Medicaid, the CMS influences the quality and accessibility of healthcare for many Americans.
Ready for a new Medicare Advantage plan?
What Does the Administrator of the CMS Do?
The Centers for Medicare and Medicaid Services administrator is essential in the U.S. healthcare system. If confirmed, Dr. Oz’s responsibilities will include overseeing Medicare and Medicaid, directing policy, and enforcing laws and regulations.
Oversight of the Three Ms
The heart of the CMS administrator’s role is managing the agency’s three major programs, known as the “3 Ms.”
- Medicare
- Medicaid (including CHIP)
- The Health Insurance Marketplace that the Affordable Care Act created
The administrator works with Congress to get funding for the programs. In 2023, these programs accounted for nearly a quarter of all federal spending, totaling an estimated $1.5 trillion. They also partner with state governments to manage Medicaid and CHIP and work with doctors, hospitals, and insurance companies.
Policy Direction and Implementation
The administrator sets the CMS direction by creating and enforcing rules that guide how the “Three Ms” operate. For example, they may influence how Medicare provides services, which benefits to offer, and how doctors and hospitals get reimbursed.
They can also affect healthcare costs, access, and quality. When healthcare needs change, the CMS administrator ensures the programs remain effective.
Ensure Compliance and Accountability
The administrator ensures the agency’s programs follow federal laws and regulations. The administrator’s role in compliance and accountability includes:
- Using federal funds appropriately
- Monitoring care quality
- Preventing fraud or abuse within the system
For Medicare beneficiaries, the administrator’s job means they can trust that their care follows established rules.
Notable Actions of Past CMS Administrators
CMS administrators have played essential roles in shaping Medicare and healthcare for many Americans:
- Mark McClellan (2004-2006) oversaw the launch of Medicare Part D prescription drug coverage.
- Donald Berwick (2010-2011) served during the rollout of the Affordable Care Act.
- Marilyn Tavenner (2013-2015) led as the CMS administrator during the launch of Healthcare.gov.
- Seema Verma (2017-2021) managed the CMS during the COVID-19 pandemic.
- Chiquita Brooks-LaSure (2021-present) currently oversees the CMS as the Inflation Reduction Act of 2022 takes effect.
Predictions for Dr. Mehmet Oz’s Tenure as CMS Administrator
Dr. Mehmet Oz is a former heart surgeon and well-known television personality. He became a household name in the 2010s when he hosted The Dr. Oz Show. In 2022, he ran for Senate in Pennsylvania but ultimately lost to John Fetterman.
Dr. Oz’s direction for CMS is still unclear, but opinions expressed by other Republicans and members of Trump’s chosen cabinet include:
- Support for cutting or revamping the Affordable Care Act’s Marketplace
- Implementing work requirements for Medicaid
- Introducing budget cuts to Medicare
Budget cuts to Medicare could lead to increased premiums or coinsurance for beneficiaries.
Medicare Advantage appears to be an interest for Dr. Oz – he has previously recorded advertisements for Medicare Advantage plans and owns stocks in two of the biggest insurance companies that offer Medicare Advantage plans.
When asked about Medicare in a 2022 AARP interview, Dr. Oz said, “We can expand Medicare Advantage plans. These plans are popular among seniors, consistently provide quality care and have a needed incentive to keep costs low.”
A CMS administrator who supports Medicare Advantage could expand the benefits plans are allowed to offer, reduce restrictions on advertising, and pay plans more.
In the short term, improvements can make Medicare Advantage plans attractive to more beneficiaries. However, expansions could become a long-term budget concern for Medicare. Attempts to fund expansion could lead to higher taxes or cuts in other areas of CMS.
President-elect Trump said in his statement announcing the nomination, “Dr. Oz will work closely with Robert F. Kennedy Jr. to take on the illness industrial complex, and all the horrible chronic diseases left in its wake.” Trump chose Kennedy to lead the Department of Health & Human Services.
Get real Medicare answers and guidance – no strings attached.
