CMS investigates double enrollments in Medicaid, CHIP 

WASHINGTON – CMS says a recent analysis of 2024 enrollment data identified 2.8 million Americans who are either enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in multiple states or simultaneously enrolled in both Medicare/CHIP and a subsidized Affordable Care Act (ACA) Exchange plan. 

The agency says it is taking action to ensure individuals are only enrolled in one program, potentially saving taxpayers about $14 billion annually. 

"HHS staff uncovered millions of Americans who were illegally or improperly enrolled in Medicaid and ACA plans," said U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. "Under the Trump Administration, we will no longer tolerate waste, fraud, and abuse at the expense of our most vulnerable citizens. With the passage of the One Big Beautiful Bill, we now have the tools to strengthen these vital programs for generations to come." 

CMS says over the past several months, software engineers collaborated with the agency to examine historical program enrollment data and found that in 2024 an average of 1.2 million Americans each month were enrolled in Medicaid/CHIP in two or more states and an average of 1.6 million Americans each month were enrolled in both Medicaid/CHIP and a subsidized Exchange plan.   

The agency says it will partner with states to reduce duplicate enrollment through three initiatives: 

• CMS will provide states with a list of individuals who are enrolled in Medicaid or CHIP in two or more states and ask states to recheck Medicaid or CHIP eligibility for these individuals. CMS will work with states to prevent individuals from losing coverage inappropriately.  
• CMS notified individuals enrolled in both Medicaid or CHIP and an FFE plan with a subsidy. These individuals are asked to take one of the following actions:  
  • Disenroll from Medicaid or CHIP, if no longer eligible;  
  • End their subsidy (with the option to end their coverage); or  
  • Notify the Exchange that the data match is incorrect and submit supporting documentation to show they are not enrolled in both Medicaid/CHIP and subsidized Exchange coverage. 
• CMS will provide SBEs with a list of individuals who are potentially enrolled in the state’s Medicaid or CHIP and a subsidized Exchange plan and ask SBEs to determine whether these individuals are dually enrolled, and if so, to implement a process, similar to the federal Exchange, to recheck eligibility. CMS will work with states to prevent individuals from losing coverage inappropriately. 

Federal regulations require Exchanges to periodically examine data for dual enrollments in Medicaid to guard against improper enrollments in subsidized Exchange plans through a process called Medicaid Periodic Data Matching (PDM). These examinations were paused under the Biden Administration to ensure that continuous coverage was maintained during the PHE, in alignment with the statutory requirement on states to maintain continuous enrollment in Medicaid or CHIP throughout the COVID public health emergency. These essential examinations have been strengthened under the first Trump Administration and increased to at least twice a year.   

“The Biden administration struggled to ensure that individuals were only enrolled in the single Medicaid or Exchange plan for which they were eligible – that ends today,” said CMS Administrator Dr. Mehmet Oz. “CMS is restarting these important checks to follow federal law. We are going to work with states to identify individuals enrolled in multiple programs and fix the duplicate enrollment problem to save taxpayers billions of dollars, while minimizing inappropriate coverage loss. This is exactly why we fought for stronger tools in the One Big Beautiful Bill Act—to go after this type of waste and finally put a stop to paying twice for the same person’s health coverage.”