The Centers for Medicare & Medicaid Services
On July 30, 1965, President Lyndon B. Johnson signed into law the bill that led to the Medicare and Medicaid. The original Medicare program included Part A (Hospital Insurance) and Part B (Medical Insurance). Today these 2 parts are called “Original Medicare.” Over the years, Congress has made changes to Medicare and more people have become eligible.
For example, in 1972, Medicare was expanded to cover the disabled, people with end-stage renal disease (ESRD) requiring dialysis or kidney transplant, and people 65 or older that select Medicare coverage. More benefits, like prescription drug coverage, have been offered.
At first, Medicaid gave medical insurance to people getting cash assistance. Today, a much larger group is covered:
States can tailor their Medicaid programs to best serve the people in their state, so there’s a wide variation in the services offered.
Medicare Part D Prescription Drug benefit
The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) made the biggest changes to the Medicare in the program in 38 years. Under the MMA, private health plans approved by Medicare became known as Medicare Advantage Plans. These plans are sometimes called "Part C" or "MA Plans.”
The MMA also expanded Medicare to include an optional prescription drug benefit, “Part D,” which went into effect in 2006.
Children’s Health Insurance Program
The Children’s Health Insurance Program (CHIP) was created in 1997 to give health insurance and preventive care to nearly 11 million, or 1 in 7, uninsured American children. Many of these children came from uninsured working families that earned too much to be eligible for Medicaid. All 50 states, the District of Columbia, and the territories have CHIP plans.
Affordable Care Act
The 2010 Affordable Care Act (ACA) brought the Health Insurance Marketplace, a single place where consumers can apply for and enroll in private health insurance plans. It also made new ways for us to design and test how to pay for and deliver health care. Medicare and Medicaid have also been better coordinated to make sure people who have Medicare and Medicaid can get quality services.
(Link: https://www.cms.gov/About-CMS/Agency-Information/History/index.html)
Milestones in History
1937
U.S. Surgeon General Thomas Parran proposed that National Health Insurance first cover Social Security beneficiaries.
1939
The Federal Security Agency was created to administer federal organizations dealing with health, education and social insurance, including the Social Security Board, Public Health Service, and Office of Education.
1945
After the Social Security Board called for beneficiary health insurance, President Harry Truman publicly lent his support to National Health Insurance.
1965
Medicare and Medicaid were enacted as Title XVIII and Title XIX of the Social Security Act, providing hospital, post-hospital extended care, and home health coverage to almost all Americans aged 65 or older (e.g., those receiving retirement benefits from Social Security or the Railroad Retirement Board), and providing states with the option of receiving federal funding for providing health care services to low-income children, their caretaker relatives, the blind, and individuals with disabilities. At the time, seniors were the population group most likely to be living in poverty; about half had health insurance coverage. To implement the Health Insurance for the Aged (Medicare) Act, the Social Security Administration (SSA) was reorganized and the Bureau of Health Insurance was established on July 30, 1965. This bureau was responsible for the development of health insurance policy. Medicaid was part of the Social Rehabilitation Service (SRS) at this time.
1966
Medicare was implemented and more than 19 million individuals enrolled by July 1.
1967
An Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) comprehensive health services benefit was established for all children getting Medicaid. Medicare was also given authority to conduct demonstration projects.
1972
Medicare eligibility was extended to individuals under age 65 with long-term disabilities and to individuals with end-stage renal disease (ESRD). Medicare was given additional authority to conduct demonstration programs. Medicaid eligibility for elderly, blind and disabled residents of a state was linked to eligibility for the newly enacted Federal Supplemental Security Income (SSI) program.
1973
The HMO Act provided start-up grants and loans for the development of health maintenance organizations (HMOs). HMOs meeting federal standards relating to comprehensive benefits and quality were established and under certain circumstances had the right to require an employer to offer coverage to employees. The Medicare statute was also amended to provide for HMOs to contract to provide Medicare benefits to beneficiaries who choose to enroll.
1977
The Health Care Financing Administration (HCFA) was established to administer the Medicare and Medicaid programs.
1980
Coverage of Medicare home health services was broadened. Medicare supplemental insurance, also called “Medigap,” was brought under federal oversight.
1981
Freedom of choice waivers and home and community-based care waivers were established in Medicaid. States were required to provide additional payments to hospitals treating a disproportionate share of low-income patients (called “disproportionate share hospitals,” or DSH).
1982
The Tax Equity and Fiscal Responsibility Act made it easier and more attractive for health maintenance organizations to contract with the Medicare program providing for Medicare payments on a full risk basis. In addition, the Act expanded the Agency’s quality oversight efforts through Peer Review Organizations (PROs).
1983
An inpatient acute care hospital prospective payment system for the Medicare program, based on patients’ diagnoses, was adopted to replace cost-based payments. The Medicare hospice benefit was established as an option for beneficiaries to receive all-inclusive care to relieve pain and manage symptoms in a home setting rather than an institutional setting.
1986
The Emergency Medical Treatment and Labor Act (EMTALA) required hospitals participating in Medicare that offer emergency services to provide appropriate medical screenings and stabilizing treatments. Medicaid coverage for pregnant women and infants (up to 1 year of age) up to 100% of the Federal Poverty Level (FPL) was established as a state option.
1987
The Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) strengthened the protections for residents of nursing homes.
1988
The Medicare Catastrophic Coverage Act of 1988 was enacted, which included the most significant changes since enactment of the Medicare program, improved hospital and skilled nursing facility benefits, covered mammography, and included an outpatient prescription drug benefit and a cap on patient liability. The Medicare Catastrophic Coverage Act also provided for Medicaid coverage for pregnant women and infants up to 100% of the FPL was mandated; special eligibility rules were established for institutionalized persons whose spouses remained in the community to prevent “spousal impoverishment.” The Qualified Medicare Beneficiary (QMB) program was established to pay Medicare premiums and cost-sharing charges for beneficiaries with incomes and resources below established thresholds. The Clinical Laboratory Improvement Amendments (CLIA) of 1988 strengthened quality performance requirements for clinical laboratories to ensure accurate and reliable laboratory tests and procedures.
1989
The Medicare drug benefit and other enhancements of Medicare coverage in the Medicare Catastrophic Coverage Act of 1988 were repealed after higher-income seniors protested new premiums. A new Medicare fee schedule for physician and other professional services, a resource-based relative value scale, replaced charge-based payments.
Medicaid coverage of pregnant women and children under age 6 up to 133% of the FPL was mandated; expanded Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements were established.
1990
Phased-in Medicaid coverage of children ages 6 through 18 under 100% of the FPL was established, and a Medicaid prescription drug rebate program was created. A specified low-income Medicare beneficiary eligibility group (SLMBs) was also established for Medicaid programs to pay Medicare premiums for beneficiaries with incomes at least 100% but not more than 120% of the FPL and limited financial resources. Additional federal standards for Medicare supplemental insurance were enacted.
1991
Medicaid Disproportionate Share Hospital (DSH) spending controls were established, and provider-specific taxes and donations to states were capped.
1995
SSA became independent of the Department of Health and Human Services (HHS). After occupying office space on the SSA campus and in other nearby buildings in Baltimore, HCFA consolidated into its own 960,000 square foot national headquarters down the road from SSA on Security Boulevard.
1996
Welfare Reform: The Aid to Families with Dependent Children (AFDC) entitlement program was replaced by the Temporary Assistance for Needy Families (TANF) block grant; the welfare link to Medicaid was severed; a new mandatory low-income group not linked to welfare was added to Medicaid; and enrollment in/termination of Medicaid was no longer automatic with receipt of welfare cash assistance. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was passed. It had several provisions. First, it amended the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code of 1986 to provide for new federal rules improving continuity or “portability” of coverage in the large group, small group and individual health insurance markets. HCFA implemented HIPAA provisions affecting the small group and individual markets.
Second, it created the Medicare Integrity Program which dedicated funding to program integrity activities and allowed HCFA to competitively contract for program integrity work. Third, it created national administrative simplification standards for electronic health care transactions. Fourth, it required HHS to issue privacy regulations if Congress failed to enact substantive privacy legislation.
1997
The Balanced Budget Act of 1997 (BBA): The Children’s Health Insurance Program (CHIP) was created; limits on Medicaid payments to disproportionate share hospitals were revised; new Medicaid managed care options and requirements for states were established. BBA also made changes to Medicare including:
1998
The Internet site Medicare.gov was launched to provide updated information about Medicare.
1999
The first annual Medicare & You handbook was mailed to all Medicare beneficiary households. The toll-free number, 1-800-MEDICARE (1-800-633-4227), became available nationwide.
The Ticket to Work and Work Incentives Improvements Act of 1999 (TWWIIA) expanded the availability of Medicare and Medicaid for certain disabled beneficiaries who return to work. The law established optional Medicaid eligibility groups and allowed states to offer a buy-in to Medicaid for working-age individuals with disabilities. The Balanced Budget Refinement Act of 1999 (BBRA) increased payments for some Medicare providers and increased the amount of Medicaid DSH funds available to hospitals in certain States and the District of Columbia. Other related legislation improved Medicaid coverage of certain women’s health services.
2000
The Benefits Improvement and Protection Act (BIPA) further increased Medicare payments to providers and managed health care organizations, reduced certain Medicare beneficiary co-payments, and improved Medicare coverage of preventive services. BIPA created a new Medicaid prospective payment system for Federally Qualified Health Centers and Rural Health Clinics (FQHCs/RHCs) and modified the amount of Medicaid DSH funds available to hospitals. It also delayed for one year the sunset of transitional medical assistance provided to families eligible for welfare.
2001
Secretary Tommy Thompson renamed the Health Care Financing Administration (HCFA) the Centers for Medicare & Medicaid Services (CMS).
2003
The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) made the most significant changes to Medicare since the program began. MMA created a new optional outpatient prescription drug benefit, effective in 2006, provided through private health plans allowing for competition among health plans to foster innovation and flexibility in coverage, covered new preventive benefits, and made numerous other changes. For the period prior to 2006, MMA created a temporary prescription discount card program. Beneficiaries with incomes less than 150% of the FPL became eligible for subsidies under the new Part D prescription drug program. MMA also required beneficiaries with higher incomes to pay a greater share of the Part B premium beginning in 2007.
There are many kinds of private health insurance policies. Different kinds of policies can offer very different kinds of benefits, and some can limit which doctors, hospitals, or other providers you can use. 2. You may have to pay coinsurance or a copayment as your share of the cost when you get a medical service, like a doctor’s visit, hospital outpatient visit, or a prescription. Coinsurance is usually a percentage amount (for example, 20% of the total cost). A copayment is usually a fixed amount (for example, you might pay $10 or $20 for a prescription or doctor’s visit). 3. You may have to pay a deductible each plan year before your insurance company starts to pay for care you get. For example, let’s say you have a $200 deductible. You go to the emergency room and the total cost is $1,250. You pay the first $200 to cover the deductible, and then your insurance starts to pay its share. 4. Health insurance plans contract with networks of hospitals, doctors, pharmacies, and health care providers to take care of people in the plan. Depending on the type of policy you buy, your plan may only pay for your care when you get it from a provider in the plan’s network, or you may have to pay a bigger share of the bill. 5. You may see products that look and sound like health insurance, but don’t give you the same protection as full health insurance.
2005
Enrollment started for Medicare Prescription Drug coverage.
2006
Medicare prescription drug coverage (Part D) began Medicare for 39 million beneficiaries. Numerous MMA provisions were implemented, including a number of new preventive services for Medicare beneficiaries.
2009
On February 4, 2009, President Obama signed the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). This legislation marked a new era in children’s coverage by providing states with significant new funding, new programmatic options, and a range of new incentives for covering children through Medicaid and the Children’s Health Insurance Program (CHIP).
2010
The Patient Protection and Affordable Care Act (ACA), commonly known as the “Affordable Care Act,” was signed into law by President Barack Obama on March 23, 2010, for the first time prohibiting health insurance companies from denying or charging more for coverage based on an individual’s health status, providing for expansion of the Medicaid program, and subsidies for insurance purchased through State-based Marketplaces to ensure that private insurance is affordable. The ACA also provided a variety of other insurance reforms, like new preventive benefit requirements and prohibitions on dollar limits, and expanded Medicare drug and preventive services benefits.
2011
3.6 million people with Medicare saved $2.1 billion on their prescription drugs thanks to the Affordable Care Act. More than 25.7 million beneficiaries in Original Medicare received at least one preventive service following a cost-sharing waiver in the Affordable Care Act.
2012
6.8 million consumers saved an estimated $1.2 billion on health insurance premiums in 2012, due to the “rate review” provision of the Affordable Care Act. 3.5 million beneficiaries saved $2.5 billion on prescription drugs, for an average of $706 per beneficiary.
2013
The Health Insurance Marketplace opened on October 1, 2013. For the first time ever, all Americans were able to shop for affordable quality health coverage, and couldn’t be denied or charged more because they had a pre-existing condition. An estimated 37.2 million Medicare beneficiaries received at least one free preventive service including an estimated 26.5 million people with Original Medicare. 4.3 million seniors and people with disabilities saved $3.9 billion on prescription drugs, or an average of $911 per beneficiary.
2014
During the first open enrollment for the Health Insurance Marketplace, 8 million people signed up for private insurance. 3 million young adults gained coverage thanks to the Affordable Care Act by being able to stay on their parents’ plan.
Looking at the additional enrollment since October 2013 when the initial Marketplace open enrollment period began, among the 49 states reporting both May 2015 Medicaid and CHIP enrollment data and data from July-September of 2013, more than 12.8 million additional individuals are enrolled in Medicaid and CHIP as of May 2015. Up to 129 million Americans with pre-existing conditions, including up to 17 million children, no longer had to worry about being denied health coverage or charged higher premiums because of their health status. 105 million Americans no longer had to worry about having their health benefits cut off after they reach a lifetime limit.
2015
The Medicare Access and CHIP Reauthorization Act (MACRA) changes the way Medicare pays physicians. It replaced the Sustainable Growth Rate (SGR) methodology with a method that’s more predictable and speeds up participation in alternative payment models. These models encourage quality and efficiency. MACRA also extended CHIP for two years, through fiscal year 2017.
(Link: https://www.cms.gov/About-CMS/Agency-Information/History/Downloads/Medicare-and-Medicaid-Milestones-1937-2015.pdf_)