HHS eliminates health insurance subsidies for 189K 'duplicate’ enrollees as part of ongoing audit
The Centers for Medicare & Medicaid Services (CMS) said its audits have discovered 189,000 beneficiaries of federal medical insurance subsidies who are ineligible, either because they are dead or represent duplicate entries in the system. The agency confirmed on Wednesday that it has cut payments to those enrollees, but added that it does not believe anyone will be losing coverage.
According to an announcement, the audit eliminated payments to people linked to Medicare, Medicaid and private insurance plans sold on the Affordable Care Act (ACA) marketplace, with more cuts on the way.
CMS said it will be ceasing to pay subsidies for another 3,500 people by the end of October, as part of an expanded crackdown on alleged fraud or waste related to purchases of health plans on government exchanges.
In total, the Trump administration said the move will save taxpayers $738 million, which it said are linked to irrelevant and improper subsidy payments. CMS Administrator Mehmet Oz, MD, said at the press conference that the agency is not trying to deny anyone healthcare but is instead purely motivated by “saving a lot of money” for legitimate services.
Oz added that the removals are a result of finishing a backlog of audits into enrollments, where the errors were found.
“When it comes to program integrity, the Biden Administration was sleeping on the job,” Oz said in a statement. “They paused looking for duplicate Medicaid and Obamacare coverage for four years, creating a backlog of hundreds of thousands of duplicate enrollments.”
“We’ve already saved nearly $6 billion, and we will continue to work hard to restore taxpayers’ confidence that the programs they fund are spending their hard-earned dollars wisely and efficiently,” he added.
CMS also said, as part of a duplicate enrollment enforcement initiative that began in 2025, Medicaid subsidies for 551,000 ineligible people have already been cut, most of whom are enrolled twice or deceased.
“Taxpayers should not foot the bill for duplicate coverage or subsidies for people who have died,” U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. said in the same statement. “HHS is identifying improper enrollments, stopping those payments, and making sure federal dollars support the Americans these programs were created to serve.”
As the statement from HHS and CMS noted, federal regulations require ACA exchanges to periodically audit subsidies to ensure dual enrollments are not bogging down the system. For Medicaid, this system is called Medicaid/CHIP Periodic Data Matching, where information from states is realigned with federal records.
The Trump administration claimed this critical examination was not happening as often as it should, with Oz and Kennedy reviving the program.
In case the determinations of duplicate or deceased ineligibility are made in error, CMS said it provides 30-day notice to all affected that their subsidies are ending, along with instructions on how to appeal by submitting documentation for a dispute resolution.
Notices are being sent out effective immediately, CMS said.
“Unauthorized” broker crackdown
In September, as part of its ongoing crackdown on what it calls fraud, waste and abuse, CMS announced it was cancelling 315,000 health plan enrollments, linked to 760,000 beneficiaries. Many of them may have been linked to unauthorized enrollments, where unscrupulous brokers operating on ACA exchanges enroll beneficiaries without their knowledge—an ongoing problem CMS has been combating.
To that end, the agency confirmed it also removed 569 agents and brokers from exchanges in September, while issuing a moratorium on new signups for brokers and agents for 2027.
CMS said the individuals whose ACA plans it cancelled were linked to applications that lacked proper documentation, including in many cases Social Security Numbers—something seen as a sign of fraud or sign-ups made without the knowledge of enrollees.
CMS said it is also taking a closer look at the agents and brokers currently operating on government exchanges. Those individuals and companies will be required to re-identify themselves using Login.gov or ID.me.
Additional systems are also being put in place to ensure applications contain complete information, including Social Security numbers, CMS added.
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