To amend the Patient Protection and Affordable Care Act to identify individuals dually enrolled in Medicaid or CHIP and an Exchange.
Summary
What This Bill Does
This ACA program-integrity bill adds a recurring dual-enrollment check to section 1311(c). Within 60 days after enactment, HHS must establish a program that compares, on a recurring basis and at least quarterly, information for each individual enrolled in a qualified health plan through an Exchange with information for each individual enrolled in Medicaid under title XIX or CHIP under title XXI, including waivers. The comparison must use the Public Assistance Reporting Information System, known as PARIS, or a successor system. The purpose is to identify people enrolled both in an Exchange qualified health plan and in Medicaid or CHIP. For individuals identified as dually enrolled, the Secretary must take appropriate actions, such as notifying applicable Exchanges and Treasury, to ensure the individual is not receiving premium tax credits under Code section 36B or cost-sharing reductions under ACA section 1402.
Who Benefits and How
Federal taxpayers benefit because federal subsidy payments should not continue for people already enrolled in Medicaid or CHIP. CMS Exchange administrators benefit from a required quarterly data-matching process using PARIS or a successor system. State Medicaid agencies and CHIP agencies benefit if duplicate Exchange enrollment issues are identified centrally rather than only through State-level reviews. Qualified health plan issuers benefit from clearer notice when enrollees should not receive Exchange subsidies because of public coverage.
Who Bears the Burden and How
HHS data-matching staff must build the program within 60 days, run comparisons at least quarterly, use PARIS or a successor system, and trigger enforcement actions. State Medicaid agencies and CHIP agencies may need to provide or maintain data suitable for matching. Exchange administrators and Treasury tax administrators must respond to notifications by adjusting premium tax credits or cost-sharing reductions. Dually enrolled individuals may lose Exchange subsidy support and face coverage-transition steps.
Key Provisions
- Requires HHS to establish a dual Medicaid or CHIP and Exchange enrollment identification program within 60 days.
- Requires recurring comparisons at least quarterly.
- Uses PARIS or a successor system to compare Exchange, Medicaid, and CHIP enrollment data.
- Requires action such as notifying Exchanges and Treasury to stop premium tax credits or cost-sharing reductions for identified dual enrollees.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Requires HHS within 60 days to run at least quarterly PARIS-based comparisons between Exchange enrollment data and Medicaid or CHIP enrollment data, then notify Exchanges and Treasury or take other action so dually enrolled individuals do not receive premium tax credits or cost-sharing reductions.
Key Policy Areas
Healthcare, Medicaid, Program Integrity
Primary Purpose
Requires HHS within 60 days to run at least quarterly PARIS-based comparisons between Exchange enrollment data and Medicaid or CHIP enrollment data, then notify Exchanges and Treasury or take other action so dually enrolled individuals do not receive premium tax credits or cost-sharing reductions.
Policy Domains
Substantive provisions
Identified Gains
- Federal taxpayers
- CMS Exchange administrators
- State Medicaid agencies
- CHIP agencies
- Qualified health plan issuers
Identified Costs
- HHS data-matching staff
- State Medicaid agencies
- CHIP agencies
- Exchange administrators
- Treasury tax administrators
- Dually enrolled individuals
Sponsors
Legislative Progress
In CommitteeMr. Burchett introduced the following bill; which was referred to …
Referred to the Committee on Energy and Commerce, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
HHS data-matching staff, Treasury tax administrators
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology