Centers for Medicare and Medicaid Services

Topics on this page: Summary of Activities that Continue | Summary of Activities that will Not Continue | Summary of Contingency Staffing Plan

Summary of Activities that Continue

The Centers for Medicare & Medicaid Services (CMS) Medicare Program will continue during a lapse in appropriations. Other non-discretionary activities including Health Care Fraud and Abuse Control and Center for Medicare & Medicaid Innovation activities will also continue.  CMS will have sufficient funding for Medicaid to fund the first quarter of FY 2025, based on the advance appropriation provided for in the FY 2024 appropriation. CMS will have sufficient funding in subsequent fiscal quarters only for regular Medicaid grant awards made within 30 days of the initiation of a lapse in appropriations, based on Section 111(b) of Public Law 118-83.   CMS will maintain the staff necessary to make payments to eligible states for the Children's Health Insurance Program (CHIP).  CMS will continue Federal Exchange activities, such as eligibility verification, using Federal Exchange user fee carryover.

Summary of Activities that will Not Continue

• Health Care Facility Survey and Certification: CMS survey and certification activities would focus on complaint investigations alleging the most serious incidents of resident or patient harm. Other survey activities, such as recertification surveys, initial surveys, and less serious complaint investigations, and all surveys by federal staff would be suspended.
• Policy and Rule Making: CMS payment rule development and other policy decisions would depend on the funding source and duration of a lapse in appropriation.  With limited staff to review and provide operational support, we would expect delays in rule-making and other policy development. 
• Contract Oversight: Under a lapse, CMS would be largely unable to provide oversight to many of its major contractors, including the Medicare Administrative Contractors, the Medicare Call Center, and other IT contractors.
• Outreach and Education: Many national and community outreach and education activities performed by CMS would cease or slow down during a lapse.  This could include local and national engagement activities, mailings, and other beneficiary facing activities. 
• Beneficiary Casework: CMS beneficiary casework services would largely suspend during a lapse in appropriations.

Summary of Contingency Staffing Plan

In the event of a lapse of appropriation, 3,365 (51%) of CMS staff will be retained including 3,155 (48%) who are exempt (their activities or position are already funded or otherwise exempt) and 210 (3%) who are excepted staff (their activities are deemed necessary by implication).

Exempt Staff:

A total of 3,155 (48%) CMS staff will be exempt. Exempt CMS staff include one HHS Officer appointed by the President and 3,154 staff who support activities that have funding available during a lapse in appropriations. CMS employees funded from a variety of non-discretionary funding sources are exempt from furlough, such as those funded from the Health Care Fraud and Abuse Control Program, Quality Improvement Organizations, Inflation Reduction Act, and user fees.

Excepted Staff:

A total of 210 (3%) CMS staff are considered excepted and can legally continue their activities in the absence of appropriations. These staff fall into the category of those whose work is "necessarily implied" from the authorized continuation of other activities. These excepted CMS employees will primarily be working to ensure that funded activities (i.e., the Medicare program) continue operations.

CMS has 88 Commissioned Corps members who will continue working under this exception.