CMS takes aim at duplicative ACA, Medicaid enrollments

fiercehealthcare ^ | 10/14/26 | Paige Minemyer

[spintreebob]

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.

CMS 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.

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.

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TOPICS: Crime/Corruption; Culture/Society; Government; News/Current Events
KEYWORDS: duplicatemedicaid; fraud; waste

[spintreebob]

Missing is the part where in 2013-14 Deloitte designed its IES iNTEGRATED ELIGIBILITY SYSTEM to be a FRAUD that enrolls duplicates in both the same state, and across states. IES also enrolls the dead and ghosts. And, of course, the DEI, Address and other data of legit enrollees is so dirty that it is very costly to determine the truth.

Deloitte is the FRAUD.

[Libloather]

How about checkin’ out SSDI for fraud? Should be a little there.

[spintreebob]

The total number on SSDI in the US is small .... smaller than one state on Medicaid. Of the SSDI most are older “workers” approaching retirement age. Most are in WV KY AR MS AL.

FRAUD? I would look for providers double-dipping ... getting paid by both Medicaid and SSDI for the same service. Many are “intellectual disability” and similar in STATE HOSPITALS. So is the state double dipping?

It is worth looking into. I would assume that when OZ is looking at the DEAD, he is looking at all programs including SSI, SSDI, Medicaid, Snap, WIC, TANF, Sec8, LIHEAP, etc. The same with DUPLICATES.