The Trump administration has put a focus on rooting out fraud, waste and abuse, and on Wednesday, regulators offered a look at progress to date in those efforts.
The Centers for Medicare & Medicaid Services said in an announcement that so far this year it has identified 189,000 people who were enrolled in Affordable Care Act exchange plans and in duplicative Medicaid, Medicare or Children’s Health Insurance Program coverage.
The agency then acted to pull ACA subsidies for these enrollees. CMS believes that addressing these duplicate enrollments could save $1.5 billion in the next year.
“No one is losing insurance coverage based on what’s happening today,” CMS Administrator Mehmet Oz, M.D., said during a briefing on Wednesday morning. “What we are doing is saving a lot of money.”
CMS reinstated efforts to address duplicative enrollment at the end of 2025, which eliminated subsidies for about 551,000 people enrolled in both ACA plans and Medicaid. Under federal regulation, insurance exchanges are required to determine when individuals are enrolled in both programs through periodic data matching protocols.
In President Donald Trump’s previous term, these checks were increased to twice per year. But CMS said that they were paused during the Biden administration under statutory requirements that sought to ensure continuous access to coverage during the COVID-19 public health emergency.
If the system flags that an individual is enrolled in both an ACA exchange plan and Medicaid coverage, that person is contacted and then has 30 days to dispute the case. If they don’t, their subsidies will be pulled, CMS said, though these individuals do have an opportunity to appeal.
A similar process is in place if data matching flags then an individual may be deceased, per the announcement.
Oz said during the briefing that a common scenario in which this type of duplication might occur is when an individual moves between states. They may switch to an ACA plan in their new location, but their previous home state still includes them in the Medicaid rolls.
There are also “shady insurance companies and unscrupulous brokers” that can seek to make money by enrolling people fraudulently, Oz said.
“These savings now go towards vulnerable Americans who truly depend on these savings. That’s where the money should have gone in the first place,” he said. “And our hope is this will continue as we proceed with additional data matching.”