CMS Finds 2.8 Million Americans Potentially Enrolled in Two or More Medicaid/ACA Exchange Plans

CMS.gov ^ | Jul 17, 2025 | CMS.gov

[ransomnote]

Unnecessary, Duplicate Enrollment Wasting $14 Billion Annually

The Centers for Medicare & Medicaid Services (CMS) continue to crush fraud, waste, and abuse in America’s healthcare programs by stopping duplicative enrollment in government health programs, with the potential to save taxpayers approximately $14 billion annually. 

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

CMS is taking action to ensure individuals are only enrolled in one program and to stop the federal government from paying multiple times for these individuals to receive health coverage. In addition, as a result of the One Big Beautiful Bill Act, CMS now has new tools to prevent the federal government from paying twice for the same person’s care—saving billions and restoring integrity to the system.

"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."

“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.”

Over the past several months, software engineers collaborated with CMS 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. 

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 essential examinations were strengthened under the first Trump Administration and increased to at least twice a year. 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. 

CMS will partner with states to reduce duplicate enrollment through three initiatives:

• Individuals Enrolled in Two or More Medicaid Programs: 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. 

• Individuals Enrolled in Medicaid or CHIP + a Subsidized Federally-facilitated Exchange (FFE) Plan: 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: 

  1) Disenroll from Medicaid or CHIP, if no longer eligible; 

  2) End their subsidy (with the option to end their coverage); or 

  3) 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.

  After 30 days, the FFE will end the subsidy for individuals who still appear to be enrolled in both Medicaid or CHIP and an Exchange plan with a subsidy.

• Individuals Enrolled in Medicaid or CHIP + a Subsidized State-based Exchange (SBE) Plan: 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.

CMS will provide additional guidance to state Medicaid and CHIP agencies in early August with expectations for tackling concurrent enrollment. The agency will follow up with lists to each state of individuals concurrently enrolled in Medicaid or CHIP and ask states to make their best efforts to recheck eligibility by late fall. Going forward, CMS will continue to work with states to provide support for their existing Medicaid/CHIP and Exchange data matching processes and work to implement new requirements in the One Big Beautiful Bill Act designed to eliminate and prevent duplicate enrollment in Medicaid programs.

### 

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on X  (Formerly Twitter) @CMSgov

---

TOPICS: Miscellaneous
KEYWORDS: chip; cms; enrollment; fraud; healthcare; medicaid; theft

[GMMC0987]

Like Dirksen said “A billion here, a billion there, and pretty soon you’re talking real money.”

[stars & stripes forever]

Will people with double coverage be required to pay back their double dipping?

[ransomnote]

It appears that it's not the recipient (patient), it's those in government collecting funds for imaginary patients, double billing on actual patient (e.g., a blood test billed to two different labs). I suppose there could be theft on the part of patients, but it's more likely institutional fraud. In CA, Medicaid 'harvests' applicants (works to put everyone on the rolls whether they want to be or not) in order to acquire federal funds for them. I've read that an applicant has to list everyone in the household and then everyone in that household gets a voter registration card and probably becomes a target for enrollment in Medicaid (contact the home, push to enroll everyone regardless of citizenship)

From a related thread: 

In the News/Activism forum, on a thread titled Together @CMSgov and DOGE uncover $14B in duplicative Medicaid and ACA enrollment. 2.8 million Americans improperly enrolled in multiple programs wasting over $14 Billion in taxpayer funding, lightman wrote:

Almost Bingo.

Two accounts...lab or other provider bills to each.

Double payments for just one patient.

What’s not to like? /s

In the News/Activism forum, on a thread titled Together @CMSgov and DOGE uncover $14B in duplicative Medicaid and ACA enrollment. 2.8 million Americans improperly enrolled in multiple programs wasting over $14 Billion in taxpayer funding, Tired of Taxes wrote:

Here’s what’s going on...

If your income falls below a limit, and you live in a state with “expanded Medicaid,” and you apply for insurance on Healthcare.gov, your name will be sent to Medicaid.

Even if you’re able to change your application and qualify for an “ACA plan” right away, Medicaid will keep your name on its list. Then, Medicaid will refuse to remove your name, even if you call multiple times and tell them to remove your name, tell them you have insurance, and never use Medicaid.

It’s funny how the politicians didn’t know that. They don’t even know what their own laws do. Many of us could’ve told “DOGE” ourselves. It wasn’t a big secret.

[metmom]

They should or be charged with fraud.

[maddog55]

On the left this means 2.8 million people dropped from medicaid and CHIP are going to die.

[Soul of the South]

“A billion here, a billion there, and pretty soon you’re talking real money.”

DOGE demonstrated in the few weeks it was active the US government is wasting hundreds of billions of dollars. As a nation we are behaving like the spoiled child who spent his inheritance on expensive toys, alcohol and drugs, sexual depravity and then accumulated a mountain of debt. The day of reckoning finally arrives when lenders say no more, the assets are sold of for pennies on the dollar, friends and family disappear, and the penniless wastrel is ends up begging in the streets.

DOGE was a wakeup call for serious minded Americans, before it was essentially coopted and neutered by the bureaucracy. Despite hundreds of billions in waste identified by DOGE the scoundrels in Congress were only able to come up with $9 billion in savings to cut in the just passed rescission bill, demonstrating they are content to enjoy the orchestra on the Titanic while the ship goes down.

[brookwood]

In some cases the patient pays for the service and then submits a claim to the insurance company for reimbursement. Each insurance company checks against its own records to make sure it is not a duplicate claim, but they can’t check against the records of the other insurance company, so double reimbursement is certainly possible. If the premiums for the insurance are paid by the insured this doesn’t work, because the insured would be paying twice the premium. But Medicaid is free, the insured pays nothing. You give some people something free, and they immediately demand more free stuff.

[Steven Tyler]

The Democrats then vote on behalf of the fake people, generated from duplicate records....

Git DOGE to root out and vaporize the duplicate records

[montag813]

Hussein Obama’s handiwork, yet again.

[Organic Panic]

I cancelled my ridiculous obamacare useless BS plan two years ago and the insurance provider still keeps sending me invoices saying they billed the government for my “premiums.” What a scam. I am sure when tax time comes around they will say I owe them even after calling every month telling them I am not enrolled in their garbage product.

[Chewbarkah]

The article being less than clear, here is a stab on how t this might have been happening — less a deliberate scam than just moronic government policy. Corrections invited.

Let’s say a low-income individual signed up on the “Exchange” for a subsidized insurance plan they pay little or nothing for. Once they consume healthcare, they find that they can’t pay thousands for the huge deductibles these policies require. So they sign up for Medicaid. The “exchange” policy cooks along, with the federal government paying for insurance no one is using. Meanwhile the federal government reimburses states, which operate Medicaid, for whatever expenses the patient consumes. The insurance company holding the unused ObamaCare policy is profitting from this and has no incentive to prompt cancellation.

I’m curious why the Bidenistas stopped crosschecking for duplication. Who specifically caused that — surely their mama gave them a name?

[goodnesswins]

I have heard THAT is exactly what is happening...an oregon hosp admin guy said so on local radio

[Jacquerie]

As encouraged in my Medicare statements, I have twice reported fraudulent claims.

After half an hour on the phone, the government employee in both situations said to the effect that they knew of the fraudulent claimants.

Oh.

My reward was two new Medicare numbers and the associated hassle with updating them with my medical providers.

I won’t bother reporting further fraud.