Trump administration boots 189,000 deceased, duplicate enrollees off ACA subsidies

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Dive Brief:

• The Trump administration has cut health subsidies for 189,000 people on the Affordable Care Act exchanges after it said it found duplicate beneficiaries on Medicaid and Medicare, and enrollees who were deceased.
• Removing those subsidies will save $738 million in improper payments this year, CMS officials said at a Wednesday press conference. 
• Officials said they plan to remove subsidies for another 3,500 people by the end of the month, as the Trump administration continues its crackdown of the ACA exchanges.

Dive Insight:

No one is losing health insurance coverage based on the Trump administration’s latest crackdown, CMS Administrator Mehmet Oz said at the press conference. “What we are doing is saving a lot of money,” he said.

The Trump administration has focused on culling enrollees it says are receiving subsidies fraudulently, or kicking people off ACA plans altogether in its broader efforts to identify “fraud, waste and abuse” in federal programs.

Last year, the Trump administration revoked subsidies from about 551,000 enrollees it said were enrolled in Medicaid and receiving duplicate ACA subsidies.

And late last month, the Trump administration said it was terminating ACA coverage for more than 760,000 people, saying their enrollment was unauthorized.

The CMS is legally required to periodically analyze data on the ACA exchanges in order to root out any overlapping coverage, like those also enrolled in Medicare or Medicaid. The first Trump administration explicitly required exchanges to conduct periodic data matching twice a year. 

Overlapping Medicaid coverage accounted for roughly 120,000 of the total cases this year, according to CMS officials. About 58,000 cases concerned duplicate Medicare coverage and about 11,000 involved deceased enrollees, CMS officials said. 

Duplicate enrollees are contacted by the CMS and have 30 days to respond. CMS also contacts the estate of any deceased enrollee, and they also have 30 days to dispute the record until their subsidies and plans are canceled.

“Some cases begin with an error, others reveal deliberate abuse,” HHS Secretary Robert F. Kennedy Jr. said during the press conference. 

It’s the latest roiling of the exchanges, which have experienced upheaval after Republicans allowed more generous financial subsidies for ACA plans to lapse last year. The loss of the assistance caused the average premium to skyrocket — about 1 in 10 enrollees polled by health policy researcher KFF said they dropped their marketplace coverage as a result and are now uninsured.