WASHINGTON, D.C. — In a sweeping effort to restore financial integrity and reduce fraud in America’s healthcare system, the Centers for Medicare & Medicaid Services (CMS) announced a major enforcement initiative to eliminate duplicate enrollments across Medicaid, the Children’s Health Insurance Program (CHIP), and subsidized Affordable Care Act (ACA) plans. The action could save taxpayers up to $14 billion annually.
According to a recent CMS analysis, roughly 2.8 million Americans were enrolled in more than one public health insurance program in 2024. This includes 1.2 million individuals enrolled in Medicaid or CHIP in multiple states, and 1.6 million who simultaneously held coverage under both Medicaid/CHIP and subsidized ACA Exchange plans. Federal law prohibits individuals from being covered by multiple programs at once, but oversight gaps—particularly during the COVID-era continuous coverage policies—have allowed this issue to grow unchecked.
The crackdown follows the enactment of the One Big Beautiful Bill Act, which granted CMS expanded tools to detect and eliminate duplicate coverage. “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.”
CMS Administrator Dr. Mehmet Oz emphasized the agency’s renewed focus: “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.”
The new effort will focus on three key areas:
- Multiple Medicaid Enrollments: CMS will provide states with lists of individuals enrolled in Medicaid or CHIP in more than one state and request that states verify eligibility.
- Dual Medicaid and Federally Facilitated Exchange Coverage: Individuals enrolled in both programs with subsidies will be contacted. If no action is taken within 30 days, their Exchange subsidies will be terminated.
- Dual Medicaid and State-Based Exchange Coverage: CMS will work with state-run Exchanges to review enrollment data and establish corrective processes similar to those used at the federal level.
While CMS aims to prevent coverage disruptions, the agency will require states to complete eligibility redeterminations by late fall. Additional guidance will be issued in early August.
The Biden Administration previously paused enforcement of these checks during the COVID public health emergency, citing a need to maintain continuous coverage. That policy has now been reversed.
With ongoing support from data scientists and new statutory mandates under the One Big Beautiful Bill Act, CMS is expanding the scope and frequency of its Medicaid Periodic Data Matching program to safeguard public funds. The agency reaffirmed its commitment to ensuring that those eligible for coverage receive it—without paying twice for the same care.
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