CMS ACA Caseworker Reductions Signal Longer Resolution Times Amid Policy Changes

The Centers for Medicare & Medicaid Services (CMS) has seen significant reductions in its ACA caseworker divisions due to a federal reduction in force initiated by the Trump administration. This cut has eliminated two out of six caseworker teams responsible for resolving coverage issues faced by the 24 million enrollees under the Affordable Care Act.

Caseworkers handle complex and critical situations such as incorrect policy enrollments, unauthorized plan switching, and errors in adding newborns to coverage, which if unresolved, can result in considerable financial burdens or denial of care for consumers.

The reduction in caseworker staff is expected to prolong resolution times beyond the previous standard of 14 days for complex cases and 2-3 days for urgent ones. The dismantling of these teams reportedly happened abruptly, with several workers losing system access without official notification, contributing to low morale within CMS's Exchange Customer Solutions Group. Alongside these cuts, other HHS agencies, including the CDC, FDA, and NIH, are also undergoing widespread job reductions aimed at decreasing total Department of Health and Human Services employees from 82,000 to 62,000, purportedly saving $1.8 billion annually.

State marketplaces operate their own separate case management systems, but the federal marketplace, which serves 31 states, depends heavily on these federal caseworkers. A notable area of caseworker focus has been on fraud involving rogue brokers who improperly switch or enroll consumers without consent, leading to network access issues and potential tax complications for those affected.

New caseworker hires require extensive training due to the complexity of health insurance rules and policies, but recent layoffs have affected even probationary staff who had just completed training. Proposed ACA changes set for 2026, including stricter eligibility documentation and monthly fees on auto-renewals, could increase consumer confusion and demand for caseworker services, exacerbating the impact of staffing shortages.

These developments highlight operational and service delivery risks within CMS as it manages ACA enrollees and underscores potential challenges for consumers navigating an evolving regulatory environment with diminished federal support resources.