# CMS The Centers for Medicare & Medicaid Services runs Medicare, Medicaid, and the ACA marketplaces — the budget core of [[Department of Health and Human Services]] and, by dollars moved, arguably the most powerful purchasing agency on Earth. Created alongside the programs themselves under the [[Medicare and Medicaid Act]] (1965). Because a CMS coverage decision instantly creates or forecloses a market, the agency is where health-industry lobbying concentrates its most surgical efforts — the dynamic currently on display in the [[Guardant Health]] colorectal-screening rulemaking that shadows [[Alex Azar]]. ## The Oz Era [[Mehmet Oz]], confirmed Administrator in April 2025, runs CMS at the intersection of two agendas: the budget bill's Medicaid restructuring and the administration's drug-pricing theater. Signature moves so far: - **Medicaid work requirements** — CMS built the nationwide implementation framework for the work mandates in the 2025 budget legislation, with Oz promising exemptions for the vulnerable while threatening penalties over "self-attestation" abuse. The midterm-relevant stakes: coverage-loss projections land hardest in red states that expanded Medicaid. - **Prior authorization expansion** — a June 2025 industry "pledge" to streamline prior authorization in Medicare Advantage and managed care, followed in January 2026 by a pilot *adding* prior authorization to traditional fee-for-service Medicare in six states (the WISeR model) — a structural shift critics read as Medicare Advantage-izing original Medicare. - **Ending the Part D premium subsidy** — on July 28, 2026 CMS announced it would discontinue the **Part D Premium Stabilization Demonstration** at the close of CY 2026, a year early, removing the payments that had suppressed standalone prescription-drug premiums during the [[Inflation Reduction Act]] benefit redesign. The 2027 national average monthly bid amount was set at $296.05, roughly 24 percent higher. Oz framed the subsidy as a "bailout" no longer needed; fifty-one House Democrats demanded reversal on August 4. Because standalone Part D is the drug benefit for people in *traditional* Medicare, the premium increase points enrollment toward [[Medicare Advantage]] — a stated [[Project 2025]] objective. See [[Medicare Part D]]. - **Coverage rulemaking as industrial policy** — the proposed national coverage framework for blood-based cancer screening (the Guardant/Shield fight), Medicare coverage for the Trump-deal GLP-1 prices, and the Medicaid/Medicare side of the [[Most-Favored-Nation Drug Pricing Deals]]. ## Why CMS Matters Here CMS is the proof that the real money in health politics is not in approval (FDA's domain) but in **reimbursement**. A drug or test without CMS coverage is a science project; with it, a gold mine. That is why the [[Revolving Door]] increasingly routes ex-officials toward diagnostics and coverage plays — see [[Alex Azar]] at [[Guardant Health]] — and why [[Big Pharma]]'s record lobbying spend targets pricing and PBM rules rather than safety regulation. ## Connections - [[Mehmet Oz]] — Administrator since April 2025 - [[Department of Health and Human Services]] — Parent department - [[Guardant Health]] / [[Alex Azar]] — Live coverage-rulemaking conflict - [[Medicare and Medicaid Act]] / [[Affordable Care Act]] / [[Inflation Reduction Act]] — Statutory spine - [[Medicare Part D]] / [[Medicare Advantage]] — The 2026 premium-subsidy termination and the privatization gradient it feeds - [[Big Pharma]] — The hub analysis