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Contact Information

CMS Press Office
202-690-6145

Programs

Medicare

Who Qualifies?

CMS runs Medicare, the nation's largest health insurance program, covering nearly 40 million Americans at a cost of just under $200 billion. Medicare provides health insurance to:

  • people age 65 or older;
  • some people with disabilities under age 65; and
  • people with permanent kidney failure requiring dialysis or a transplant.

What are the benefits?

Medicare has two parts: Hospital Insurance (Part A) and Medical Insurance (Part B).

Medicare Part A helps pay for inpatient hospital services, skilled nursing facility services, home health services, and hospice care.

Medicare Part B helps pay for doctor services, outpatient hospital services, medical equipment and supplies, and other health services and supplies.

Many Choices for Getting Benefits

People who qualify for Medicare may have choices beyond the traditional Original Medicare Plan. Some people may have Medicare Managed Care Plans or Private Fee-for-Service Plans available in their area. These options are health plans offered by private insurance companies. Check medicare.gov for a listing of options available in a given geographical area.

Where to Apply



Medicaid

Medicaid is a health insurance program for certain low-income people. It is funded and administered through a state-federal partnership. Although there are broad federal requirements for Medicaid, states have a wide degree of flexibility to design their program. States have authority to:

  • establish eligibility standards;
  • determine what benefits and services to cover;
  • set payment rates.

Who Qualifies?

On any given day, there are about 36 million people who are eligible for Medicaid. These people include: certain low-income families with children; certain low-income people who are aged, blind or disabledcertain low-income pregnant women and children; and people who have very high medical bills.

What are the Benefits?

Because states have flexibility in structuring their Medicaid programs, there are variations from state to state. All states, however, must cover these basic services: inpatient and outpatient hospital services; laboratory and X-ray services, skilled nursing and home health services, doctors' services; family planning; and periodic health checkups, diagnosis and treatment for children.

Where to apply?

People can generally apply for Medicaid at local Public assistance offices or social service offices. Many states have now made it possible to apply in other locations, such as hospitals and public health clinics, or in some cases by mail. For information is available on this website or by calling 410-786-2542.

State Children's Health Insurance Program (SCHIP)

CMSruns the State Children's Health Insurance Program. Program benefits became available October 1, 1997, and will provide $24 billion in federal matching funds over 5 years to help states expand health care coverage to over 5 million of the nation's uninsured children.

Who Qualifies?

States set eligibility and coverage, following broad federal guidelines. States also have flexibility in the way they provide services. Recipients in all states must have low incomes, be otherwise ineligible for Medicaid, and be uninsured.

What are the Benefits?

State programs differ, but all states must cover at least these services: inpatient and outpatient hospital services, doctors' surgical and medical services, laboratory and X-ray services, and well baby/child care, including immunizations. Some states may provide additional benefits. Benefits are not yet available in all States.

Where to Apply?

People can apply for Children's Health Insurance Program benefits at state welfare offices, state public health departments, and state social service agencies.

Clinical Laboratory Improvement Amendments of 1988 (CLIA)

The Clinical Laboratory Improvement Amendments of 1988 (CLIA) established quality standards for all laboratory testing to ensure the accuracy, reliability and timeliness of patient test results regardless of where the test was performed. A laboratory is defined as any facility that performs laboratory testing on specimens derived from humans for the purpose of providing information for the diagnosis, prevention, treatment of disease, or impairment of, or assessment of health.

CMS is charged with the implementation of CLIA, including laboratory registration, fee collection, certificate generation, surveys, surveyor guidelines development and training, enforcement, financial management, and finally, approvals of proficiency testing providers, accrediting organizations and exempt states. The Food and Drug Administration is responsible for test categorization. The Centers for Disease Control and Prevention is responsible for the CLIA studies, convening the Clinical Laboratory Improvement Amendments Committee (CLIAC) and provides scientific and technical support to CMS.

Who Qualifies/Is Subject to CLIA Requirements?

CLIA requires all entities that perform even one test (including tests waived under CLIA and those not billed to Medicare) on specimens derived from humans for the purposes of providing information for the diagnosis, prevention, treatment of disease, or impairment of, or assessment of the health of a human being to meet applicable Federal requirements. The CLIA requirements are based on the complexity of the tests performed. The more complex the test, the more stringent the requirements.

What are the Benefits?

The objective of the CLIA Program is to ensure the quality of laboratory testing for all individuals tested, regardless of where the test is performed. Data from CLIA inspections and proficiency testing reflect that laboratories have improved performance over time and that CLIA facilitates that improvement using an educational approach.

Where to Apply?

CMS has made available the Clinical Laboratory Improvement Amendments of 1988 Application for Certification, Form HCFA-116. This form should be completed and returned to the address of the local State Agency for the State in which the laboratory performing the test(s) resides.

Last Modified on Thursday, September 16, 2004