HHS Targets $14 Billion in Savings by Addressing Duplicate Medicaid and ACA Enrollments

The U.S. Department of Health and Human Services (HHS) has identified nearly 3 million cases of potential improper enrollment where individuals are simultaneously receiving benefits from multiple government health programs, including Medicaid, the Children's Health Insurance Program (CHIP), and subsidized Affordable Care Act (ACA) exchange plans. These duplications are seen as a source of avoidable government expenditure, with an estimated potential savings of $14 billion annually for taxpayers. The Centers for Medicare & Medicaid Services (CMS) is collaborating with states to investigate and resolve these duplicate enrollments to prevent redundant payments.

Medicaid and CHIP are state-administered programs offering health coverage to low-income populations, while the ACA exchange plans are administered by both federal and state entities. Confusion over eligibility, income fluctuations, changes in family status, and residency moves contribute to these overlapping enrollments. For instance, a Medicaid recipient whose income rises might become eligible for an ACA plan but fail to notify Medicaid, causing both programs to cover the same individual simultaneously.

Correcting these duplications requires significant resources, and states face limited financial incentives to pursue such investigations since the federal government primarily funds Medicaid costs (up to 90% for expansion populations). Additionally, political challenges may arise due to the interests of enrollees and industries benefiting from the current enrollment processes.

CMS will supply states with lists of suspected duplicate enrollees and request eligibility re-verifications. Individuals identified as enrolled in both Medicaid/CHIP and subsidized ACA plans will be asked to provide documentation or disenroll from one program. CMS intends to minimize undue coverage loss while maximizing cost recovery by working closely with states.

This initiative reflects ongoing federal efforts to address program integrity and reduce government waste in healthcare spending. It highlights the complexities of overlapping public health insurance eligibility systems and the need for coordinated administrative measures. The enforcement is also part of broader fiscal responsibility objectives amid concerns over rising federal healthcare expenditures.