30 Jul 2.8 MILLION DUPLICATE ENROLLMENTS REPORTED BY CMS: MEDICAID REQUIRES SMARTER DATA INFRASTRUCTURE
The Centers for Medicare & Medicaid Services (CMS) has reported a significant number of duplicate Medicaid enrollments across public health programs, raising concerns about inefficiencies and the growing need for advanced data systems to support prevention efforts. In 2024 alone, 2.8 million individuals were found to be enrolled in more than one taxpayer-funded coverage program.
CMS, working alongside software engineers, identified two main issues in its review:
- 1.2 million people were enrolled in Medicaid or CHIP in multiple states, and
- 1.6 million individuals held coverage in both Medicaid and subsidized ACA Marketplace plans.
Duplicate Medicaid enrollments are costing the Medicaid program billions of dollars annually. This overlap represents a substantial challenge for Managed Care Organizations (MCOs). The teams responsible for Coordination of Benefits (COB) and Third-Party Liability (TPL) are actively working to ensure accurate coverage and payment alignment. However, they continue to face roadblocks from fragmented systems, inconsistent data-sharing practices, and slow updates to eligibility.
The result is that many of these conflicts are only uncovered after payments have been made, requiring plans to spend time and resources chasing recoveries instead of avoiding improper payments in the first place.
“Plans aren’t failing to do the work. They’re being asked to manage a national-scale eligibility challenge without the modern tools required to solve it,” noted one industry expert.
Duplicate enrollment can trigger a chain reaction of waste and disruption, from misrouted claims and provider confusion to delays in care and improper expenditures. Medicaid plans have established internal processes to identify these issues, but without real-time enrollment visibility, they are compelled to act retroactively.
CMS’s findings only reinforce what Medicaid MCOs have been advocating: it’s time for an infrastructure upgrade. Cost avoidance cannot be achieved solely through manual processes and outdated systems. Plans need interoperable platforms, timely data, and coordinated eligibility signals to prevent overlap at the point of care or enrollment.
To keep Medicaid strong, sustainable, and focused on those who rely on it, state and federal agencies must support investments in next-generation eligibility technology. With more innovative tools at hand, Medicaid plans can better achieve the program’s goals.
Medicaid managed care plans are ready to preserve resources—what’s needed now is the data infrastructure to let them do it proactively.