CMS Actions Against Fraud and Waste
- CMS aims to eliminate fraud, waste, and abuse in healthcare programs.
- Potential savings for taxpayers estimated at $14 billion annually.
- Analysis revealed 2. 8 million Americans were enrolled in multiple health programs.
Duplicate Enrollment Issues
- Identified individuals enrolled in Medicaid or CHIP across multiple states.
- Identified individuals enrolled in both Medicaid/CHIP and subsidized ACA Exchange plans.
- CMS is taking steps to ensure each person is enrolled in only one program.
Strengthening Systems with New Tools
- One Big Beautiful Bill Act provides CMS with tools to prevent double payments for care.
- Secretary Robert F. Kennedy, Jr. emphasized ending waste and fraud.
Resuming Important Checks
- CMS will enforce checks to ensure compliance with federal enrollment laws.
- Plans to collaborate with states to identify and fix duplicate enrollments.
- Aim to save taxpayers billions while minimizing coverage loss.
Historical Enrollment Data Findings
- Average of 1. 2 million individuals per month enrolled in dual Medicaid/CHIP programs.
- Average of 1. 6 million per month enrolled in both Medicaid/CHIP and subsidized plans.
Regulations on Data Matching
- Federal regulations require periodic checks for dual enrollments.
- Checks were paused during the Biden Administration to maintain continuous coverage during COVID-19.
Initiatives to Reduce Duplicate Enrollment
1. Two or More Medicaid Programs
- CMS will provide states a list of individuals enrolled in multiple states for rechecking eligibility.
- Collaboration to prevent inappropriate loss of coverage.
2. Medicaid/CHIP and Subsidized Federal Exchange (FFE) Plan
- Individuals notified about their dual enrollments.
- Actions required: disenroll if ineligible, end subsidy, or report incorrect matches.
3. Medicaid/CHIP and Subsidized State-based Exchange (SBE) Plan
- States will receive lists of individuals for dual enrollment checks.
- Similar to FFE, recheck eligibility to prevent overlap.
Upcoming Actions from CMS
- Guidance for state Medicaid and CHIP agencies expected in early August.
- Lists of concurrently enrolled individuals will be sent to states.
- Continued work with states to implement new requirements to eliminate duplicate enrollment.
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